MEDICARE: KREATIVE MINDS OF BATON ROUGE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1518463934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KREATIVE MINDS OF BATON ROUGE

Provider Business Mailing Address
First Line	:	11745 BRICKSOME AVE STE B1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2369
Country	:	US
Telephone Number	:	225-291-5492
Fax Number	:	225-291-5456

Provider Business Practice Location Address
First Line	:	11745 BRICKSOME AVE STE B1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2369
Country	:	US
Telephone Number	:	225-291-5492
Fax Number	:	225-291-5456

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LISA BROWN
Credential	:
Telephone Number	:	225-291-5492

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	01/15/2025

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