Organization
MIND CHANGING INC
Active
Parent organization
SHANTA SMITH
Other names
SHANTA SMITH
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHANTA SMITH
Authorized official
VANESSA DOMINGUE (OFFICE MANAGER)
(337) 643-8424
Entity
Organization
Contact information
Practice address
3817 CANAL BANK DR, SLIDELL, LA 70461-6644
(504) 875-9443
(337) 643-8407
Mailing address
PO BOX 85, KAPLAN, LA 70548-0085
(337) 643-8424
(337) 643-8407
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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