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General NPI Number Information
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NPI Number | 1184990517
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Entity Type | Organization
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Legal Business Name | EDUCATIONAL AND TREATMENT COUNCIL, INC.
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 2400 MERGANSER ST BUILDING B
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City | LAKE CHARLES
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State | LA
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Zip | 70615-6898
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Country | US
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Telephone | 337-433-1062
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 864
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City | LAKE CHARLES
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State | LA
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Zip | 70602-0864
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Country | US
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Telephone | 337-433-1062
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. AMY DUNN
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Credential | LCSW
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Telephone | 337-433-1062
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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 | 2347
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 14681
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 039
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License Number State | LA
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