Provider Demographics
NPI:1447876289
Name:HEADACHE CLINIC OF CENLA
Entity type:Organization
Organization Name:HEADACHE CLINIC OF CENLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-664-1817
Mailing Address - Street 1:211 N 3RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8568
Mailing Address - Country:US
Mailing Address - Phone:318-625-7299
Mailing Address - Fax:318-625-7169
Practice Address - Street 1:211 N 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8568
Practice Address - Country:US
Practice Address - Phone:318-625-7299
Practice Address - Fax:318-625-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811203318OtherNPI