Healthcare Provider Details

I. General information

NPI: 1275240228
Provider Name (Legal Business Name): ACADIAN HOLISTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 4TH AVE STE 215
LAKE CHARLES LA
70601-7887
US

IV. Provider business mailing address

2829 4TH AVE # 215
LAKE CHARLES LA
70601-7887
US

V. Phone/Fax

Practice location:
  • Phone: 337-707-3872
  • Fax:
Mailing address:
  • Phone: 337-429-5105
  • Fax: 337-888-9853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOHNSON
Title or Position: PROGRAM ADMINISTRATOR/OWNER
Credential:
Phone: 337-707-3872