MEDICARE: CENTER FOR PSYCHOLOGICAL HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376800961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR PSYCHOLOGICAL HEALTH CARE

Provider Business Mailing Address
First Line	:	861 MAIN ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-5529
Country	:	US
Telephone Number	:	225-383-3013
Fax Number	:	225-383-0030

Provider Business Practice Location Address
First Line	:	861 MAIN ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-5529
Country	:	US
Telephone Number	:	225-383-3013
Fax Number	:	225-383-0030

Authorized Official
Title or Position	:	CEO/PSYCHOLOGIST
Name	:	DR. IVORY TOLDSON
Credential	:	ED.D.
Telephone Number	:	225-383-3013

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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