Healthcare Provider Details

I. General information

NPI: 1235364415
Provider Name (Legal Business Name): EAST ST. TAMMANY MENTAL HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 1ST ST
SLIDELL LA
70458-3605
US

IV. Provider business mailing address

2237 1ST ST
SLIDELL LA
70458-3605
US

V. Phone/Fax

Practice location:
  • Phone: 985-641-0619
  • Fax:
Mailing address:
  • Phone: 985-641-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: CHERI M CARTER
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 985-641-0619