Provider Demographics
NPI:1598831356
Name:SOUTH LOUISIANA HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH LOUISIANA HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-913-4189
Mailing Address - Street 1:121 SAMUEL ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-5363
Mailing Address - Country:US
Mailing Address - Phone:504-261-6659
Mailing Address - Fax:
Practice Address - Street 1:121 SAMUEL ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-5363
Practice Address - Country:US
Practice Address - Phone:504-261-6659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health