Provider Demographics
NPI:1699083444
Name:PALMTREE PSYCHIATRIC MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:PALMTREE PSYCHIATRIC MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JEANENE
Authorized Official - Middle Name:TOOMBS
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-892-2784
Mailing Address - Street 1:11078 SAVOY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AMANT
Mailing Address - State:LA
Mailing Address - Zip Code:70774-4003
Mailing Address - Country:US
Mailing Address - Phone:225-892-2784
Mailing Address - Fax:337-643-8407
Practice Address - Street 1:8235 YMCA PLAZA DR
Practice Address - Street 2:SUITE
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0939
Practice Address - Country:US
Practice Address - Phone:225-769-2441
Practice Address - Fax:225-769-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05977363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2120280Medicaid