Provider Demographics
NPI:1760734156
Name:JOHN EHRET SCHOOL BASED HEALTH CENTER MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:JOHN EHRET SCHOOL BASED HEALTH CENTER MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-575-3712
Mailing Address - Street 1:2900 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4605
Mailing Address - Country:US
Mailing Address - Phone:504-057-5371
Mailing Address - Fax:504-575-3691
Practice Address - Street 1:4300 PATRIOT ST
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4305
Practice Address - Country:US
Practice Address - Phone:504-731-1318
Practice Address - Fax:504-731-1328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS HEALTH LOUISIANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-09
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty