Organization Name: | NORTHLAKE MEDICAL PSYCHOLOGY AND COUNSELING |
NPI Number: | 1043692437 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN A TEAL (MEDICAL PSYCHOLOGIST) |
Mailing Address: | 215 Saint Ann Dr Ste 2 Mandeville |
State: | LA US |
Postal Code: | 704713394 |
Phone Number: | 6019461844 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2015 |
NPI Last Update Date: | 07/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | LPC #3492 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |