| Organization Name: | MMO OF GONZALES, LLC |
| NPI Number: | 1093883522 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT L. MILLER (CEO) |
| Mailing Address: | 305 South Burnside Ave. Suite D Gonzales |
| State: | LA US |
| Postal Code: | 70737 |
| Phone Number: | 2256212760 |
| Fax Number: | 2256212768 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 07/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 531032 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |