Family Life Developmental Center
Clinic/Center, Mental Health (Including Community Mental Health Center) in Ruston, LA. Organization (NPI-2).
NPI number1679858054
StatusActive
Last updated in NPPESOct 17, 2011
Details
- NPI
- 1679858054
- Entity type
- Organization (NPI-2)
- Legal business name
- Family Life Developmental Center
- Organization subpart
- No
- Enumeration date
- Oct 17, 2011
- Last updated
- Oct 17, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
829 E Georgia Ave Ste 5Ruston, LA 71270-3901
Phone 318-255-8405 · Fax 318-255-8417
Mailing address
829 E Georgia Ave Ste 5Ruston, LA 71270-3901
Phone 318-255-8405 · Fax 318-255-8417
Authorized official
Alphonso Bingham
Administrator/Ceo
3182558405
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