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NPI Code Detail

MEDICARE: COGNITIVE DEVELOPMENT CENTER BEHAVIORAL HEALTH SERVICES

MEDICARE: COGNITIVE DEVELOPMENT CENTER BEHAVIORAL HEALTH SERVICES
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
1251S00000XCommunity/Behavioral Health AgencySA0010541LA
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1992187322
Entity Type Code : Organization
Provider Name (Legal Business Name) : COGNITIVE DEVELOPMENT CENTER BEHAVIORAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 101 FEU FOLLET RD STE 100
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-4234
Country : US
Telephone Number : 337-234-8455
Fax Number :
Provider Business Practice Location Address
First Line : 4951 CENTRAL AVE
Second Line :
City : MONROE
State : LA
Zip : 71203-6156
Country : US
Telephone Number : 318-340-1535
Fax Number : 318-340-1539
Authorized Official
Title or Position : SEASIDE HC BILLING SUPERVISOR
Name : GEMMALYN PRYOR
Credential :
Telephone Number : 337-234-8280
Provider Enumeration Date : 06/22/2015
Last Update Date : 07/07/2023

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