Provider Demographics
NPI:1750264057
Name:WESTSIDE MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:WESTSIDE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:225-223-7322
Mailing Address - Street 1:4540 FORET ST
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710-2553
Mailing Address - Country:US
Mailing Address - Phone:225-223-7322
Mailing Address - Fax:
Practice Address - Street 1:4540 FORET ST
Practice Address - Street 2:
Practice Address - City:ADDIS
Practice Address - State:LA
Practice Address - Zip Code:70710-2553
Practice Address - Country:US
Practice Address - Phone:225-223-7322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty