MEDICARE: ALLEN TEMPLE BAPTIST CHURCH

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	101YP2500X	Professional Counselor	187	LA

General Provider Information

NPI Number	:	1942430657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN TEMPLE BAPTIST CHURCH

Provider Business Mailing Address
First Line	:	5120 EASTERLYN CIR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-5200
Country	:	US
Telephone Number	:	504-301-3636
Fax Number	:	504-301-3636

Provider Business Practice Location Address
First Line	:	5120 EASTERLYN CIR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-5200
Country	:	US
Telephone Number	:	504-301-3636
Fax Number	:	504-301-3636

Authorized Official
Title or Position	:	DIRECTOR/PASTOR
Name	:	MR. DONALD PAUL MILLER
Credential	:	CCS
Telephone Number	:	504-344-5566

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	07/16/2009

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