1881969210 NPI number — NATCHITOCHES BEHAVIORAL HEALTH CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881969210 NPI number — NATCHITOCHES BEHAVIORAL HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATCHITOCHES BEHAVIORAL HEALTH CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881969210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATCHITOCHES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71457-6052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-357-3122
Provider Business Mailing Address Fax Number:
318-357-3240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHITOCHES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71457-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-357-3122
Provider Business Practice Location Address Fax Number:
318-357-3240
Provider Enumeration Date:
03/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
LASHAWNDA
Authorized Official Middle Name:
Authorized Official Title or Position:
REGISTERED ADDICTIONS COUNSELOR
Authorized Official Telephone Number:
318-357-3122

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  1288 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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