Provider Demographics
NPI:1922254119
Name:CENTRAL CITY BEHAVORIAL HEALTH CLINIC
Entity Type:Organization
Organization Name:CENTRAL CITY BEHAVORIAL HEALTH CLINIC
Other - Org Name:DHH/MHSD/CCBHC
Other - Org Type:Other Name
Authorized Official - Title/Position:SOCIAL WORKER 5
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/GSW
Authorized Official - Phone:504-568-7101
Mailing Address - Street 1:2221 PHILIP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-2525
Mailing Address - Country:US
Mailing Address - Phone:504-568-6650
Mailing Address - Fax:
Practice Address - Street 1:2535 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-3013
Practice Address - Country:US
Practice Address - Phone:504-568-6650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVISION OF HEALTH & HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1710652261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health