Healthcare Provider Details

I. General information

NPI: 1457822751
Provider Name (Legal Business Name): IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E NAPOLEON ST
SULPHUR LA
70663
US

IV. Provider business mailing address

4105 KIRKMAN ST
LAKE CHARLES LA
70607-4603
US

V. Phone/Fax

Practice location:
  • Phone: 337-475-3100
  • Fax:
Mailing address:
  • Phone: 337-475-3100
  • Fax: 337-475-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NIKYIA BROWN
Title or Position: CREDENTIALING SPEC.
Credential:
Phone: 337-475-3100