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Organization
LIFENET
Active
Organization
LIFENET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARISSA TAYLOR PHD (OWNER)
(985) 778-9141
Entity
Organization
Contact information
Practice address
4050 LONESOME RD, STE A, MANDEVILLE, LA 70448-7085
(985) 778-9141
Mailing address
4050 LONESOME RD, STE A, MANDEVILLE, LA 70448-7085
(985) 778-9141
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
AP03867
LA
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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