Organization
ECLECTIC COGNITIVE BEHAVIORAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELINE M MIMS EDD, PHD (CLINICAL DIRECTOR/CEO)
(225) 924-2800
Entity
Organization
Contact information
Practice address
1733 WOODDALE BLVD, BATON ROUGE, LA 70806-1508
(225) 924-2800
(225) 924-2800
Mailing address
1733 WOODDALE BLVD, BATON ROUGE, LA 70806-1508
(225) 924-2800
(225) 924-2800
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
3676
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600559886
—
LA
Enumeration date
03/31/2014
Last updated
08/08/2015
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