Healthcare Provider Details

I. General information

NPI: 1922254119
Provider Name (Legal Business Name): CENTRAL CITY BEHAVORIAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 S CARROLLTON AVE
NEW ORLEANS LA
70118-3013
US

IV. Provider business mailing address

2221 PHILIP ST
NEW ORLEANS LA
70113-2525
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-6650
  • Fax:
Mailing address:
  • Phone: 504-568-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1710652
License Number StateLA

VIII. Authorized Official

Name: MRS. BRENDA S GRAYSON
Title or Position: SOCIAL WORKER 5
Credential: MSW/GSW
Phone: 504-568-7101