Provider Demographics
NPI:1952008773
Name:COMPREHENSIVE WELLNESS AND MENTAL HEALTH LLC
Entity type:Organization
Organization Name:COMPREHENSIVE WELLNESS AND MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP APRN FNP PMHNP
Authorized Official - Phone:985-381-3494
Mailing Address - Street 1:2043 COTEAU RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-2165
Mailing Address - Country:US
Mailing Address - Phone:985-323-6420
Mailing Address - Fax:985-202-4028
Practice Address - Street 1:2043 COTEAU RD STE 104
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-2165
Practice Address - Country:US
Practice Address - Phone:985-323-6420
Practice Address - Fax:985-202-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1422541Medicaid
LA1205076403OtherNPI