Healthcare Provider Details

I. General information

NPI: 1225183213
Provider Name (Legal Business Name): DISNEY & ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 JEFFERSON DR
LAKE CHARLES LA
70605-5713
US

IV. Provider business mailing address

133 JEFFERSON DR
LAKE CHARLES LA
70605-5713
US

V. Phone/Fax

Practice location:
  • Phone: 337-431-7194
  • Fax: 279-205-3136
Mailing address:
  • Phone: 337-431-7194
  • Fax: 279-205-3136

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2203783669
License Number StateLA

VIII. Authorized Official

Name: KAREN LYNNE ELFERT
Title or Position: BUSINESS MANAGER
Credential:
Phone: 337-431-7194