Organization
WILLIAM TUCKER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE POWELL LMFT (CLINICAL DIRECTOR)
(225) 275-3039
Entity
Organization
Contact information
Practice address
820 ONEAL LN, BATON ROUGE, LA 70816-1805
(706) 200-0197
Mailing address
6630 SIEGEN LN APT 262, BATON ROUGE, LA 70809-4583
(706) 200-0197
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/06/2016
Last updated
01/06/2016
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