Healthcare Provider Details

I. General information

NPI: 1104190636
Provider Name (Legal Business Name): CHILD & ADOLESCENT BEHAVIORAL HEALTH SYSTEM/WEST BANK CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 GENERAL MEYER AVE 100
NEW ORLEANS LA
70131-3588
US

IV. Provider business mailing address

4422 GENERAL MEYER AVE 100
NEW ORLEANS LA
70131-3588
US

V. Phone/Fax

Practice location:
  • Phone: 504-361-6092
  • Fax: 504-361-6250
Mailing address:
  • Phone: 504-361-6092
  • Fax: 504-361-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GILDA ARMSTRONG BUTLER
Title or Position: DIRECTOR
Credential: LCSW
Phone: 225-252-9107