Healthcare Provider Details

I. General information

NPI: 1154180644
Provider Name (Legal Business Name): SCHS - YOUTH MOBILE CRISIS SERVICES IND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 E RAILROAD AVE
INDEPENDENCE LA
70443-2710
US

IV. Provider business mailing address

PO BOX 770
ZACHARY LA
70791-0770
US

V. Phone/Fax

Practice location:
  • Phone: 225-306-2060
  • Fax: 225-308-2572
Mailing address:
  • Phone: 225-306-2067
  • Fax: 225-222-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA FOSTER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 225-306-2067