MEDICARE: BETHLEHEM BAPTIST CHURCH OFBR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	SA20007669	LA

General Provider Information

NPI Number	:	1184097933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHLEHEM BAPTIST CHURCH OFBR

Provider Business Mailing Address
First Line	:	2274 WOODDALE BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1444
Country	:	US
Telephone Number	:	225-928-1088
Fax Number	:	225-934-9488

Provider Business Practice Location Address
First Line	:	2274 WOODDALE BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1444
Country	:	US
Telephone Number	:	225-928-1088
Fax Number	:	225-932-9488

Authorized Official
Title or Position	:	CLINICAL SUPERVISOR
Name	:	MS. PATRICE BUTLER
Credential	:	CAC, CCS
Telephone Number	:	225-928-1088

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

Similar Medicare Providers

1083087555 — GENITA DAWSON
Practice Location Address:

2274 WOODDALE BLVD
BATON ROUGE, LA
70806-1444

Practice Phone: 225-928-1088
Practice Fax: 225-932-9488

1699148155 — MS. PATRICE BUTLER
Practice Location Address:

2274 WOODDALE BLVD
BATON ROUGE, LA
70806-1444

Practice Phone: 225-928-1088
Practice Fax:

1043683444 — JACKIE SIMMONS MSP, CIT3407
Practice Location Address:

2274 WOODDALE BLVD
BATON ROUGE, LA
70806-1444

Practice Phone: 225-928-1088
Practice Fax:

1891168290 — CAROL ANDERSON
Practice Location Address:

2274 WOODDALE BLVD
BATON ROUGE, LA
70806-1444

Practice Phone: 225-928-1088
Practice Fax: 225-932-9488

1073689378 — DR. SETH KUNEN PH.D., PSY.D.
Practice Location Address:

2435 DRUSILLA LN
BATON ROUGE, LA
70809-1444

Practice Phone: 225-802-0942
Practice Fax: 225-412-3830

1184978561 — VIVECA JOHNSON LPC
Practice Location Address:

2435 DRUSILLA LN STE F
BATON ROUGE, LA
70809-1444

Practice Phone: 225-508-3253
Practice Fax: 225-647-3167

Directions to “BETHLEHEM BAPTIST CHURCH OFBR ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.