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General NPI Number Information
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NPI Number | 1073082780
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Entity Type | Organization
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Legal Business Name | CENTER FOR PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 252 HECTOR AVE STE A
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City | GRETNA
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State | LA
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Zip | 70056-2548
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Country | US
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Telephone | 504-417-3728
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1756
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City | GRETNA
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State | LA
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Zip | 70054-1756
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Country | US
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Telephone | 504-435-1444
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Fax | 504-372-2775
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Authorized Official
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Title or Position | CEO
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Name | MS. MARY ESTHER MARTINEZ
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Credential |
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Telephone | 504-417-3728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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