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General NPI Number Information
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NPI Number | 1154603215
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Entity Type | Organization
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Legal Business Name | STONEBRIDGE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 2837 ERNEST ST STE C
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8785
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Country | US
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Telephone | 337-274-2689
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Fax | 337-542-4226
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | CALHOUN
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State | LA
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Zip | 71225-0489
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Country | US
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Telephone | 318-644-2737
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Fax | 337-542-4226
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Authorized Official
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Title or Position | OWNER
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Name | MR. HARVEY F MARCUS SR.
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Credential |
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Telephone | 318-644-2737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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