Healthcare Provider Details

I. General information

NPI: 1851902167
Provider Name (Legal Business Name): GREG ALLEN TIRITILLI RAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CORA DR
BATON ROUGE LA
70815-4201
US

IV. Provider business mailing address

150 CORA DR
BATON ROUGE LA
70815-4201
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-1611
  • Fax: 225-347-5300
Mailing address:
  • Phone: 225-387-1611
  • Fax: 225-347-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1387
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: