Healthcare Provider Details

I. General information

NPI: 1346415643
Provider Name (Legal Business Name): SET FREE INDEED MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10473 OLD HAMMOND HWY
BATON ROUGE LA
70816-8264
US

IV. Provider business mailing address

10473 OLD HAMMOND HWY
BATON ROUGE LA
70816-8264
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-1910
  • Fax:
Mailing address:
  • Phone: 225-924-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number315
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number315
License Number StateLA

VIII. Authorized Official

Name: MRS. TONJA MYLES
Title or Position: CEO
Credential:
Phone: 225-924-1910