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NPI Code Detail

MEDICARE: IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY

MEDICARE: IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)80LA

Other Identifiers

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

General Provider Information

NPI Number : 1902944184
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
Provider Business Mailing Address
First Line : 4105 KIRKMAN ST STE B
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-4603
Country : US
Telephone Number : 337-475-3100
Fax Number : 337-475-3105
Provider Business Practice Location Address
First Line : 106 W PORT ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-4040
Country : US
Telephone Number : 337-462-1641
Fax Number : 337-462-1354
Authorized Official
Title or Position : CREDENTIALING SPEC.
Name : NIKYIA BROWN
Credential :
Telephone Number : 337-475-3100
Provider Enumeration Date : 02/01/2007
Last Update Date : 12/12/2025

Similar Medicare Providers

1306984513 — MRS. SHARRON SANDERS LEWIS LCSW
Practice Location Address:
106 W PORT ST
DERIDDER, LA
70634-4040
Practice Phone: 337-462-1641
Practice Fax:
1477691699 — MRS. NATHA L GANTT LCSW
Practice Location Address:
106 W PORT ST
DERIDDER, LA
70634-4040
Practice Phone: 337-462-1641
Practice Fax: 337-462-1354
1053450486 — MRS. JESSICA MAY WILLIAMS-ASHMORE MA, LPC
Practice Location Address:
106 W PORT ST
DERIDDER, LA
70634-4040
Practice Phone: 337-462-1641
Practice Fax:
1629319223 — BEAUREGARD BEHAVIORAL HEALTH CLINIC
Practice Location Address:
106 W PORT ST
DERIDDER, LA
70634-4040
Practice Phone: 337-462-1641
Practice Fax:
1245618651 — MR. STEPHEN KIRK BILLEAUDEAUX R.N.
Practice Location Address:
106 W PORT ST
DERIDDER, LA
70634-4040
Practice Phone: 337-462-1461
Practice Fax:
1184071243 — MRS. JESSLYN PEARSON LANGBEIN LPC, CFLE
Practice Location Address:
106 W PORT ST
DERIDDER, LA
70634-4040
Practice Phone: 337-462-1354
Practice Fax:

Directions to “IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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