Organization
MMO OF COVINGTON, LLC
Active
Other names
North Lake Community Mental Health, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT L. MILLER (EXECUTIVE OFFICER)
(225) 293-6774
Entity
Organization
Contact information
Practice address
201 GREENBRIAR BLVD, COVINGTON, LA 70433-7236
(985) 249-7780
(985) 249-7782
Mailing address
728 NORTH BLVD, BATON ROUGE, LA 70802-5724
(225) 293-6774
(225) 291-9229
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
194701
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8303
OCCUPATIONAL LICENSE
LA
Enumeration date
05/26/2006
Last updated
07/02/2010
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