Individual
SHIRLEY MAMOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1140 SHIRLEY RD, BUNKIE, LA 71322-1545
(318) 346-8001
(318) 346-8005
Mailing address
PO BOX 749, MARKSVILLE, LA 71351-0749
(318) 305-6233
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1544761
—
LA
01
—
1679507412
NPI
LA
Enumeration date
09/08/2016
Last updated
08/14/2017
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