Organization
THE STRESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EBERT H. VAN BUREN (OWNER/PSYCHOLOGIST)
(318) 323-6162
Entity
Organization
Contact information
Practice address
2215 LIBERTY ST, MONROE, LA 71201-3623
(318) 323-6162
Mailing address
2215 LIBERTY ST, MONROE, LA 71201-3623
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
30
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
436-26-17660
BLUE CROSS/BLUE SHIELD
—
Enumeration date
09/04/2007
Last updated
09/04/2007
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