Provider Demographics
NPI:1386185791
Name:GENESIS HOUSING, COUNSELING AND OUTREACH SERVICES, INC.
Entity Type:Organization
Organization Name:GENESIS HOUSING, COUNSELING AND OUTREACH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MAZANT
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-342-7574
Mailing Address - Street 1:10001 LAKE FOREST BLVD STE 613
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-6201
Mailing Address - Country:US
Mailing Address - Phone:504-908-6241
Mailing Address - Fax:504-389-1117
Practice Address - Street 1:10001 LAKE FOREST BLVD STE 613
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6201
Practice Address - Country:US
Practice Address - Phone:504-908-6241
Practice Address - Fax:504-389-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783801251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty