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General NPI Number Information
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NPI Number | 1205031044
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Entity Type | Organization
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Legal Business Name | LOUISIANA YOUTH ENHANCED SERVICES
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8 VERSAILLES BLVD
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City | NEW ORLEANS
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State | LA
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Zip | 70125-4114
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Country | US
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Telephone | 504-866-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 210 STATE ST COTTAGE #4
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City | NEW ORLEANS
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State | LA
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Zip | 70118-5735
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Country | US
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Telephone | 504-896-2636
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Fax | 504-896-2668
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Authorized Official
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Title or Position | ASSOCIATE CLINICAL DIRECTOR
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Name | MRS. KAWANA RIPOLL
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Credential | LCSW
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Telephone | 504-896-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD.09289R
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License Number State | LA
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