Organization
JEFFERSON PARISH SERVIE AUTHORITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKAL MATTON (THERAPIST)
(504) 838-5257
Entity
Organization
Contact information
Practice address
2400 EDENBORN AVE, METAIRIE, LA 70001-1817
(504) 838-5257
Mailing address
2400 EDENBORN AVE, METAIRIE, LA 70001-1817
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
3130
LA
Other
Enumeration date
06/07/2010
Last updated
06/07/2010
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