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Organization
MENT LC
Active
Organization
MENT LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERICA MITCHELL (OWNER)
(225) 725-2812
Entity
Organization
Contact information
Practice address
4500 GOVERNMENT ST # 64655, BATON ROUGE, LA 70806-5817
(225) 725-2812
Mailing address
4500 GOVERNMENT ST # 64655, BATON ROUGE, LA 70806-5817
(225) 725-2812
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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