Provider Demographics
NPI:1083760003
Name:DEPARTMENT OF HEALTH AND HOSPITALS
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH AND HOSPITALS
Other - Org Name:NEW IBERIA MENTAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIORAL HEALTH MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YANCEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-373-0002
Mailing Address - Street 1:611 W ADMIRAL DOYLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-0000
Mailing Address - Country:US
Mailing Address - Phone:337-373-0002
Mailing Address - Fax:337-373-0129
Practice Address - Street 1:611 W ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-0000
Practice Address - Country:US
Practice Address - Phone:337-373-0002
Practice Address - Fax:337-373-0129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF HEALTH AND HOPSITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA292101YA0400X
LA134261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1083760003Medicaid
LA1710661Medicaid
LA57329Medicare PIN