Individual
LARRY-MICHAEL MENCER-ACLISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2460 COLLEGE DR, BATON ROUGE, LA 70808-2445
(225) 239-5293
Mailing address
2460 COLLEGE DR, BATON ROUGE, LA 70808-2445
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
NONE
—
Enumeration date
07/01/2019
Last updated
07/01/2019
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