Provider Demographics
NPI:1598802233
Name:DEPARTMENT OF HEALTH AND HOSPITALS
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH AND HOSPITALS
Other - Org Name:TALLULAH MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-574-1713
Mailing Address - Street 1:1012 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-5216
Mailing Address - Country:US
Mailing Address - Phone:318-574-1713
Mailing Address - Fax:318-574-2299
Practice Address - Street 1:1012 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-5216
Practice Address - Country:US
Practice Address - Phone:318-574-1713
Practice Address - Fax:318-574-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA90261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710351Medicaid
LA1710351Medicaid