Organization
THERAPEUTIC MEDICAL & PSYCHIATRIC SERVICES LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE PRIVITOR PRIVITOR DAVIS APRN, FNP-C, PMHNPBC (OWNER)
(318) 816-5116
Entity
Organization
Contact information
Practice address
1501 STUBBS AVE, MONROE, LA 71292-1106
(318) 396-9712
(180) 051-8423
Mailing address
200 WINTERPARK DR, WEST MONROE, LA 71292-1106
(318) 396-9712
(180) 051-8423
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APO5002
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000000000
PRIVATE INSURANCE
LA
Enumeration date
05/01/2011
Last updated
12/03/2024
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