Organization
SOUTHEAST LOUISIANA STATE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA B GONZALES MSW LCSW (CEO)
(915) 626-6300
Entity
Organization
Contact information
Practice address
23515 HWY 190, SOUTHEAST LOUISIANA STATE HOSPITAL, MANDEVILLE, LA 70448
(985) 626-6300
(985) 626-6557
Mailing address
PO BOX 3850, SOUTHEAST LOUISIANA STATE HOSPITAL, MANDEVILLE, LA 70470-3850
(985) 626-6300
(985) 626-6557
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
214
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1946109
—
LA
01
—
5D455
MEDICARE
—
Enumeration date
06/27/2008
Last updated
06/27/2008
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