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General NPI Number Information
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NPI Number | 1154876456
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Entity Type | Organization
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Legal Business Name | CRESENT COMMUNITY OUTREACH
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 10001 LAKE FOREST BLVD
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City | NEW ORLEANS
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State | LA
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Zip | 70127-6200
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Country | US
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Telephone | 504-323-3440
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Fax |
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Provider Business Mailing Address
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Address Line | 3731 DUPLESSIS ST
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City | NEW ORLEANS
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State | LA
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Zip | 70122-1528
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MHP
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Name | BROOKE PRICE
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Credential |
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Telephone | 504-319-5745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 008909029
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License Number State | LA
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