Provider Demographics
NPI:1629018585
Name:FAMILY THERAPY CLINIC OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:FAMILY THERAPY CLINIC OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MP
Authorized Official - Phone:225-292-0155
Mailing Address - Street 1:PO BOX 83980
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-3980
Mailing Address - Country:US
Mailing Address - Phone:225-292-0155
Mailing Address - Fax:844-715-7911
Practice Address - Street 1:7738 DON BUDGE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1710
Practice Address - Country:US
Practice Address - Phone:225-292-0155
Practice Address - Fax:844-715-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty