Healthcare Provider Details

I. General information

NPI: 1245516897
Provider Name (Legal Business Name): YOUTH SERVICE BUREAU OF ST TAMMANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N NEW HAMPSHIRE ST
COVINGTON LA
70433-2830
US

IV. Provider business mailing address

430 N NEW HAMPSHIRE ST
COVINGTON LA
70433-2830
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-2570
  • Fax: 985-893-2758
Mailing address:
  • Phone: 985-893-2570
  • Fax: 985-893-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number194A
License Number StateLA

VIII. Authorized Official

Name: MR. CLEVELAND WESTER
Title or Position: PRESIDENT & CEO
Credential: LCSW
Phone: 985-893-2570