Organization
NORTHLAKE MEDICAL PSYCHOLOGY AND COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN A TEAL PHD, MP (MEDICAL PSYCHOLOGIST)
(601) 946-1844
Entity
Organization
Contact information
Practice address
215 SAINT ANN DR STE 2, MANDEVILLE, LA 70471-3394
(601) 946-1844
Mailing address
215 SAINT ANN DR STE 2, MANDEVILLE, LA 70471-3394
(601) 946-1844
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
LPC #3492
LA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
MP.000036
LA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
MP.0020
LA
Other
Enumeration date
06/23/2015
Last updated
07/29/2015
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