Provider Demographics
NPI:1316475007
Name:LICE CLINICS OF AMERICA OF NORTH LOUISIANA, LLC
Entity type:Organization
Organization Name:LICE CLINICS OF AMERICA OF NORTH LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-243-7213
Mailing Address - Street 1:2519 N 7TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5125
Mailing Address - Country:US
Mailing Address - Phone:318-582-5929
Mailing Address - Fax:318-582-5959
Practice Address - Street 1:2519 N 7TH ST STE 2
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5125
Practice Address - Country:US
Practice Address - Phone:318-582-5929
Practice Address - Fax:318-582-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty