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Organization
MAGNIFICENT MINDS TELEMED
Active
Organization
MAGNIFICENT MINDS TELEMED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMARCUS PATTERSON (OWNER)
(504) 908-0715
Entity
Organization
Contact information
Practice address
630 W CORNERVIEW ST STE B, GONZALES, LA 70737-2742
(225) 647-4105
Mailing address
PO BOX 359, GONZALES, LA 70707-0359
(504) 915-0705
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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