Provider Demographics
NPI:1982258745
Name:SOUTHERN PSYCHIATRY LLC
Entity Type:Organization
Organization Name:SOUTHERN PSYCHIATRY LLC
Other - Org Name:MELISSA ELLIS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:225-803-1142
Mailing Address - Street 1:41452 BESS RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5700
Mailing Address - Country:US
Mailing Address - Phone:225-803-1142
Mailing Address - Fax:
Practice Address - Street 1:41452 BESS RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-5700
Practice Address - Country:US
Practice Address - Phone:225-803-1142
Practice Address - Fax:225-803-1142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MELISSA ELLIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-30
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty