Healthcare Provider Details

I. General information

NPI: 1215149950
Provider Name (Legal Business Name): LOUISIANA HEALTH & REHABILITATION COPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 WEBB ST
LAFAYETTE LA
70501-3930
US

IV. Provider business mailing address

1033 N LOBDELL AVE
BATON ROUGE LA
70806-2233
US

V. Phone/Fax

Practice location:
  • Phone: 337-267-7375
  • Fax: 337-269-5615
Mailing address:
  • Phone: 225-231-2490
  • Fax: 225-231-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPCA 11826
License Number StateLA

VIII. Authorized Official

Name: MS. SOUNDRA JOHNSON TEMPLE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 225-938-0661