Provider Demographics
NPI:1225183213
Name:DISNEY ASSOCIATES
Entity Type:Organization
Organization Name:DISNEY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ELFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-431-7194
Mailing Address - Street 1:133 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5713
Mailing Address - Country:US
Mailing Address - Phone:337-431-7194
Mailing Address - Fax:279-205-3136
Practice Address - Street 1:133 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5713
Practice Address - Country:US
Practice Address - Phone:337-431-7194
Practice Address - Fax:279-205-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783669251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1649929Medicaid