Healthcare Provider Details

I. General information

NPI: 1649883240
Provider Name (Legal Business Name): OYDESSY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 CANAL ST
NEW ORLEANS LA
70119-6111
US

IV. Provider business mailing address

1533 CRICKET CT
GRETNA LA
70056-7790
US

V. Phone/Fax

Practice location:
  • Phone: 504-715-6142
  • Fax:
Mailing address:
  • Phone: 504-715-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSA THOMASON
Title or Position: MANAGER
Credential:
Phone: 504-821-9211