Organization
MIRACLE OUTLOOK FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA JACKSON (OWNER)
(318) 343-0400
Entity
Organization
Contact information
Practice address
101 LAKESHORE DR, SUITE 12, MONROE, LA 71203-4954
(318) 343-0400
Mailing address
101 LAKESHORE DR, SUITE 12, MONROE, LA 71203-4954
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
LA
Other
Enumeration date
02/08/2011
Last updated
02/08/2011
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