Provider Demographics
NPI:1104041573
Name:ST. MARTIN PARISH SCHOOL BOARD
Entity Type:Organization
Organization Name:ST. MARTIN PARISH SCHOOL BOARD
Other - Org Name:CECILIA SBHC
Other - Org Type:Other Name
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:337-909-3045
Mailing Address - Street 1:328 N MAIN ST
Mailing Address - Street 2:P.O. BOX 1344
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4923
Mailing Address - Country:US
Mailing Address - Phone:337-909-3040
Mailing Address - Fax:337-332-5458
Practice Address - Street 1:1021 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:CECILIA
Practice Address - State:LA
Practice Address - Zip Code:70521-0000
Practice Address - Country:US
Practice Address - Phone:337-909-3960
Practice Address - Fax:337-667-7228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARTIN PARISH SCHOOL BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-13
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1389477001251300000X
261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446441Medicaid