Provider Demographics
NPI:1407078934
Name:NAMI SOUTHEAST LOUISIANA
Entity type:Organization
Organization Name:NAMI SOUTHEAST LOUISIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPECIAL PROJECTS
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-626-6538
Mailing Address - Street 1:23577 MARTIN WAY
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7394
Mailing Address - Country:US
Mailing Address - Phone:985-626-6538
Mailing Address - Fax:773-618-1631
Practice Address - Street 1:2051 EIGHTH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-368-1944
Practice Address - Fax:504-368-9784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC2583251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1926221Medicaid