MEDICARE: COMPREHENSIVE MENTAL HEALTH CENTER OF BATON ROUGE, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60105	OTHER	LA	BCBS

General Provider Information

NPI Number	:	1790886588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MENTAL HEALTH CENTER OF BATON ROUGE, LLC

Provider Business Mailing Address
First Line	:	5550 THOMAS RD
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70811-7354
Country	:	US
Telephone Number	:	225-778-1100
Fax Number	:	225-778-1199

Provider Business Practice Location Address
First Line	:	5550 THOMAS RD
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70811-7354
Country	:	US
Telephone Number	:	225-778-1100
Fax Number	:	225-778-1199

Authorized Official
Title or Position	:	CORPORATE COMPLIANCE OFFICER
Name	:	ANNE L DILL
Credential	:
Telephone Number	:	337-785-8003

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/01/2010

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