Provider Demographics
NPI:1316787914
Name:M&M MENTAL HEALTH AND WELLNES LLC
Entity type:Organization
Organization Name:M&M MENTAL HEALTH AND WELLNES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEATON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:985-516-8050
Mailing Address - Street 1:58331 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-0506
Mailing Address - Country:US
Mailing Address - Phone:985-516-8050
Mailing Address - Fax:985-781-4319
Practice Address - Street 1:201 GREENBRIER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7236
Practice Address - Country:US
Practice Address - Phone:985-516-8050
Practice Address - Fax:985-781-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty