Healthcare Provider Details

I. General information

NPI: 1629018585
Provider Name (Legal Business Name): FAMILY THERAPY CLINIC OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7738 DON BUDGE AVE
BATON ROUGE LA
70810-1710
US

IV. Provider business mailing address

PO BOX 83980
BATON ROUGE LA
70884-3980
US

V. Phone/Fax

Practice location:
  • Phone: 225-292-0155
  • Fax: 844-715-7911
Mailing address:
  • Phone: 225-292-0155
  • Fax: 844-715-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERICH G DUCHMANN
Title or Position: OWNER/MANAGER
Credential: PHD, MP
Phone: 225-292-0155