Healthcare Provider Details

I. General information

NPI: 1336288778
Provider Name (Legal Business Name): DHH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 W SHAMROCK AVE UNIT 1
PINEVILLE LA
71360-6439
US

IV. Provider business mailing address

242 W SHAMROCK AVE UNIT 1
PINEVILLE LA
71360-6439
US

V. Phone/Fax

Practice location:
  • Phone: 318-484-6850
  • Fax: 318-484-6844
Mailing address:
  • Phone: 318-484-6850
  • Fax: 318-484-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number87
License Number StateLA

VIII. Authorized Official

Name: MS. REBECCA CRAIG
Title or Position: FACILITY MANAGER
Credential:
Phone: 318-484-6850