Organization
OUR LADY OF THE LAKE
Active
Other names
Family Center for Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA WHITE (DIRECTOR OF BUSINESS SERVICES)
(225) 765-4251
Entity
Organization
Contact information
Practice address
7777 HENNESSY BLVD, SUITE 6000, BATON ROUGE, LA 70808-4300
(225) 765-8648
(225) 765-7898
Mailing address
7777 HENNESSY BLVD, SUITE 6000, BATON ROUGE, LA 70808-4300
(225) 765-8648
(225) 765-7898
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03085883
—
MS
05
—
1446751
—
LA
Enumeration date
07/28/2005
Last updated
05/11/2011
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