Healthcare Provider Details

I. General information

NPI: 1194173005
Provider Name (Legal Business Name): ARRAY OF HOPE OUTREACH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 BRICKSOME AVE STE C
BATON ROUGE LA
70816-2594
US

IV. Provider business mailing address

11940 BRICKSOME AVE STE C
BATON ROUGE LA
70816-2594
US

V. Phone/Fax

Practice location:
  • Phone: 225-250-5829
  • Fax: 225-250-5879
Mailing address:
  • Phone: 225-250-5829
  • Fax: 225-250-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DEMETRICE MARIE CLARK
Title or Position: ADMINISTRATOR
Credential:
Phone: 225-253-1277