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NPI Code Detail

MEDICARE: STEPHEN HEARD RAC

MEDICARE: STEPHEN HEARD RAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1481LA

General Provider Information

NPI Number : 1306316062
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN HEARD RAC
Provider Business Mailing Address
First Line : 18639 PERKINS RD LOT 23
Second Line :
City : PRAIRIEVILLE
State : LA
Zip : 70769-3277
Country : US
Telephone Number : 949-485-0419
Fax Number : 225-343-5300
Provider Business Practice Location Address
First Line : 150 CORA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70815-4201
Country : US
Telephone Number : 949-485-0419
Fax Number : 225-343-5300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2018
Last Update Date : 11/26/2018

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Directions to “ STEPHEN HEARD RAC” Practice Location

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