Organization · Type 2 NPI

Mmo of Gonzales, LLC

Mental Health Clinic/Center (Including Community Mental Health Center) · Gonzales, LA

NPI number 1093883522 Active

Practice location

305 South Burnside Ave., Suite D
Gonzales, LA 70737

Call (225) 621-2760 Map

Fax (225) 621-2768

Mailing address

728 North Blvd
Baton Rouge, LA 70802-5724

Specialties and licenses

Taxonomy	Code	License
Mental Health Clinic/Center (Including Community Mental Health Center) Primary	261QM0801X	531032 (LA)

Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...

Other mental health clinic/center (including community mental health center) providers in Gonzales

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NPI record

NPI: 1093883522
Entity type: Organization (Type 2)
Issued: Dec 1, 2006
Last updated: Jul 2, 2010
Status: Active

Other names

<unavail>
On Track Community Health Center LLC Dbasilver Options Center On-Track · former legal business name

Authorized official

Mr. Robert L. Miller
CEO
(225) 293-6774

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1093883522

Mmo of Gonzales, LLC's National Provider Identifier is 1093883522, issued on Dec 1, 2006. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Gonzales, LA. The record was last updated on Jul 2, 2010.