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General NPI Number Information
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NPI Number | 1255759148
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Entity Type | Organization
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Legal Business Name | FELICIANAS' YOUTH OF DISTINCTION BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 10105 PLANK RD STE A
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City | CLINTON
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State | LA
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Zip | 70722-3707
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Country | US
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Telephone | 225-244-7026
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Fax | 225-244-7028
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Provider Business Mailing Address
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Address Line | 10105 PLANK RD STE A
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City | CLINTON
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State | LA
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Zip | 70722-3707
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Country | US
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Telephone | 225-244-7026
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Fax | 225-244-7028
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MRS. STEPHANIE SPANN GILMORE
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Credential | MA
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Telephone | 225-244-7026
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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 |
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License Number State |
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