MEDICARE: IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1457822751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY

Provider Business Mailing Address
First Line	:	4105 KIRKMAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-4603
Country	:	US
Telephone Number	:	337-475-3100
Fax Number	:	337-475-3105

Provider Business Practice Location Address
First Line	:	2651 E NAPOLEON ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663
Country	:	US
Telephone Number	:	337-475-3100
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPEC.
Name	:	NIKYIA BROWN
Credential	:
Telephone Number	:	337-475-3100

Provider Enumeration Date	:	12/12/2018
Last Update Date	:	12/12/2025

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Directions to “IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY ” Practice Location

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