MEDICARE: SOUTHERN SELECT HOUSING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	103TA0400X	Addiction (Substance Use Disorder) Psychologist
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist
5	106S00000X	Behavior Technician
6	111N00000X	Chiropractor
7	133N00000X	Nutritionist
8	163W00000X	Registered Nurse
9	171400000X	Health & Wellness Coach
10	183500000X	Pharmacist
11	261QA0600X	Adult Day Care Clinic/Center
12	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1184555112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN SELECT HOUSING LLC

Provider Business Mailing Address
First Line	:	12518 WYNDY AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4759
Country	:	US
Telephone Number	:	225-445-6370
Fax Number	:

Provider Business Practice Location Address
First Line	:	12518 WYNDY AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4759
Country	:	US
Telephone Number	:	225-445-6370
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TREY JOSEPH IVERSTINE
Credential	:	LMT
Telephone Number	:	225-445-6370

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “SOUTHERN SELECT HOUSING LLC ” Practice Location

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