MEDICARE: SOUTHWEST LOUISIANA AIDS COUNCIL

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	251B00000X	Case Management Agency	CM 4387	LA
2	251S00000X	Community/Behavioral Health Agency
3	261Q00000X	Clinic/Center
4	261QD0000X	Dental Clinic/Center
5	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
6	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1558431106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST LOUISIANA AIDS COUNCIL

Provider Business Mailing Address
First Line	:	425 KINGSLEY ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-3533
Country	:	US
Telephone Number	:	337-439-5861
Fax Number	:	337-436-8713

Provider Business Practice Location Address
First Line	:	1715 COMMON ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-6135
Country	:	US
Telephone Number	:	337-439-5861
Fax Number	:	337-436-8713

Authorized Official
Title or Position	:	CEO
Name	:	TERRY L ESTES
Credential	:
Telephone Number	:	337-292-0619

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/20/2025

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