Healthcare Provider Details

I. General information

NPI: 1154603215
Provider Name (Legal Business Name): STONEBRIDGE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 ERNEST ST STE C
LAKE CHARLES LA
70601-8785
US

IV. Provider business mailing address

PO BOX 489
CALHOUN LA
71225-0489
US

V. Phone/Fax

Practice location:
  • Phone: 337-274-2689
  • Fax: 337-542-4226
Mailing address:
  • Phone: 318-644-2737
  • Fax: 337-542-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. HARVEY F MARCUS SR.
Title or Position: OWNER
Credential:
Phone: 318-644-2737