Healthcare Provider Details

I. General information

NPI: 1619192010
Provider Name (Legal Business Name): ST. MARTIN PARISH SCHOOL BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 N MAIN ST
BREAUX BRIDGE LA
70517-4923
US

IV. Provider business mailing address

328 N MAIN ST P.O. BOX 1344
BREAUX BRIDGE LA
70517-4923
US

V. Phone/Fax

Practice location:
  • Phone: 337-909-3040
  • Fax: 337-332-5458
Mailing address:
  • Phone: 337-909-3040
  • Fax: 337-332-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1389477001
License Number StateLA

VIII. Authorized Official

Name: MISS ADRIENNE MICHELLE HUVAL
Title or Position: COORDINATOR
Credential: LPC-S
Phone: 337-909-3040