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General NPI Number Information
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NPI Number | 1083760003
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF HEALTH AND HOSPITALS
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 611 W ADMIRAL DOYLE DR
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City | NEW IBERIA
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State | LA
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Zip | 70560-0000
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Country | US
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Telephone | 337-373-0002
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Fax | 337-373-0129
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Provider Business Mailing Address
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Address Line | 611 W ADMIRAL DOYLE DR
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City | NEW IBERIA
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State | LA
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Zip | 70560-0000
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Country | US
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Telephone | 337-373-0002
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Fax | 337-373-0129
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH MANAGER
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Name | MR. YANCEY MIRE
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Credential | LPC
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Telephone | 337-373-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 292
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License Number State | LA
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Taxonomy #2
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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 | 134
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License Number State | LA
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