Organization
IMPACT BEHAVIORAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIESHAN MADISON MA (CLINICIAN)
(504) 394-1774
Entity
Organization
Contact information
Practice address
4700 WICHERS DR, SUITE 205, MARRERO, LA 70072-3041
(504) 407-0709
(504) 333-6252
Mailing address
4700 WICHERS DR, SUITE 205, MARRERO, LA 70072-3041
(504) 407-0709
(504) 333-6252
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
LA
Other
Enumeration date
02/10/2016
Last updated
02/10/2016
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