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General NPI Number Information
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NPI Number | 1457789802
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Entity Type | Organization
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Legal Business Name | IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 3505 5TH AVE SUITE C
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City | LAKE CHARLES
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State | LA
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Zip | 70607-2156
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Country | US
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Telephone | 337-475-3100
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Fax | 337-475-3105
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Provider Business Mailing Address
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Address Line | 3505 5TH AVE SUITE C
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City | LAKE CHARLES
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State | LA
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Zip | 70607-2156
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Country | US
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Telephone | 337-475-3100
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Fax | 337-475-3105
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. TANYA MCGEE
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Credential | LAC
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Telephone | 337-475-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 95
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License Number State | LA
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