Southeast Mental Health LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SOUTHEAST MENTAL HEALTH LLC

Practice address

300 W Morris Ave
Hammond, LA 70403-4120

Phone

(318) 473-0863

Fax

(318) 473-9889

NPI assigned

Sep 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Renessa L Fowlkes

Title

Billing Supervisor

Phone

(318) 473-0863

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Goree Gandolfo, LPC

  • Professional Counselor
  • Covington, LA
  • NPI 1740457092
  NPD (past)
• Kristi L Massengale, LCSW

  • Clinical Social Worker
  • Hammond, LA
  • NPI 1437226925
  NPD (past)
• Michael Eugene Traylor, LCSW

  • Clinical Social Worker
  • Hammond, LA
  • NPI 1871752170
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1356442099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 BAYOU RAPIDES RD",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713033601",
            "telephone_number": "318-473-0863",
            "fax_number": "318-473-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W MORRIS AVE",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704034120",
            "telephone_number": "318-473-0863",
            "fax_number": "318-473-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "FOWLKES",
        "authorized_official_first_name": "RENESSA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "318-473-0863"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "61350",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Family Medical Practice
• Southeast Louisiana Ahec Foundation, Inc
• Southeast Louisiana Area Health Education Foundation, Inc.
• Southeast Louisiana Veterans Health Care System (Hammond Outpatient Clinic)
• Southeast Menatal Health
• Southeastern Louisiana Univerisity (SLU Sports Medicine)
• Southeastern Louisiana University
• Southern Grace Hospice North LLC
• Southern Medical
• Southern Neurointerventional Institute

• Mental Health Clinic/Center (Including Community Mental Health Center) in Hammond, LA
• Providers in Hammond, LA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.