Mmo of Gonzales, LLC

NPI #1093883522 in Gonzales, Louisiana

Provider Information

NPI Number: 1093883522
Entity Type: Organization
Organization Name: Mmo of Gonzales, LLC
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Dec 1, 2006
Last Updated: Jul 2, 2010

Practice Location

Address: 305 SOUTH BURNSIDE AVE.
Address 2: SUITE D
City: Gonzales
State: Louisiana
ZIP Code: 70737
Phone: (225) 621-2760

Authorized Official

Name: MR. ROBERT L. MILLER
Title: CEO
Phone: (225) 293-6774

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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