Healthcare Provider Details

I. General information

NPI: 1376308270
Provider Name (Legal Business Name): PEOPLE UNITED OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TOWER DR STE B
MONROE LA
71201-5045
US

IV. Provider business mailing address

PO BOX 77053
BATON ROUGE LA
70879-7053
US

V. Phone/Fax

Practice location:
  • Phone: 318-570-5400
  • Fax: 318-570-5403
Mailing address:
  • Phone: 318-570-5400
  • Fax: 318-570-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE ROACH
Title or Position: REGIONAL DIRECTOR
Credential: MBA, MSW
Phone: 318-570-5400