Provider Demographics
NPI:1942430657
Name:ALLEN TEMPLE BAPTIST CHURCH
Entity Type:Organization
Organization Name:ALLEN TEMPLE BAPTIST CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PASTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CCS
Authorized Official - Phone:504-344-5566
Mailing Address - Street 1:5120 EASTERLYN CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-5200
Mailing Address - Country:US
Mailing Address - Phone:504-301-3636
Mailing Address - Fax:504-301-3636
Practice Address - Street 1:5120 EASTERLYN CIR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-5200
Practice Address - Country:US
Practice Address - Phone:504-301-3636
Practice Address - Fax:504-301-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty