Healthcare Provider Details

I. General information

NPI: 1720133978
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH AND HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5159 HIGHWAY 4 E
COLUMBIA LA
71418-3580
US

IV. Provider business mailing address

2513 FERRAND STREET
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-649-2333
  • Fax: 318-362-3268
Mailing address:
  • Phone: 318-362-3270
  • Fax: 318-362-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number120
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number369
License Number StateLA

VIII. Authorized Official

Name: MARK DEBORD
Title or Position: REGIONAL ADMINISTRAT
Credential: LCSW
Phone: 318-362-3270