Organization
BETA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA ANITA WARREN MASTERS (MHP)
(225) 485-8375
Entity
Organization
Contact information
Practice address
936 N BON MARCHE DR, BATON ROUGE, LA 70806-2257
(225) 929-6355
(225) 929-6354
Mailing address
936 N BON MARCHE DR, BATON ROUGE, LA 70806-2257
(225) 929-6355
(225) 929-6354
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1159204
—
LA
Enumeration date
02/11/2016
Last updated
02/11/2016
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