Healthcare Provider Details

I. General information

NPI: 1003802745
Provider Name (Legal Business Name): BAKER COMMUNITY MENTAL HEALTH CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 MAIN ST
BAKER LA
70714-2322
US

IV. Provider business mailing address

PO BOX 668
BAKER LA
70704-0668
US

V. Phone/Fax

Practice location:
  • Phone: 225-771-1510
  • Fax: 225-771-1520
Mailing address:
  • Phone: 225-771-1510
  • Fax: 225-771-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number014945
License Number StateLA

VIII. Authorized Official

Name: MRS. JESSICA L COWART
Title or Position: OFFICE MANAGER
Credential:
Phone: 225-771-1510