Provider Demographics
NPI:1043557275
Name:MICHAEL GAINES AND FAITH, LLC
Entity Type:Organization
Organization Name:MICHAEL GAINES AND FAITH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-636-2638
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70704-0157
Mailing Address - Country:US
Mailing Address - Phone:225-636-2638
Mailing Address - Fax:225-778-5068
Practice Address - Street 1:2944 RAY WEILAND DR
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3250
Practice Address - Country:US
Practice Address - Phone:225-636-2638
Practice Address - Fax:225-778-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1656251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1438341Medicaid
LA3C915Medicare PIN
LA3C915Medicare PIN