Organization
MIRACLE PLACE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA TAYLOR (ADMINISTRATOR)
(318) 509-9376
Entity
Organization
Contact information
Practice address
117 N WASHINGTON ST, BASTROP, LA 71220-3842
(318) 556-3378
Mailing address
117 N WASHINGTON ST, BASTROP, LA 71220-3842
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
11/18/2015
Last updated
11/18/2015
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