Provider Demographics
NPI:1992227425
Name:ANCHOR MENTAL HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:ANCHOR MENTAL HEALTH AND WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:BETHANNE
Authorized Official - Middle Name:FONDREN
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHMNP
Authorized Official - Phone:409-720-8709
Mailing Address - Street 1:1943 BARBE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5748
Mailing Address - Country:US
Mailing Address - Phone:409-720-8709
Mailing Address - Fax:
Practice Address - Street 1:1943 BARBE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5748
Practice Address - Country:US
Practice Address - Phone:409-720-8709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09425363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty