Provider Demographics
NPI:1023315983
Name:BETHLEHEM BAPTIST CHURCH
Entity type:Organization
Organization Name:BETHLEHEM BAPTIST CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:CAC, CCS
Authorized Official - Phone:225-928-1088
Mailing Address - Street 1:1011 N BON MARCHE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2262
Mailing Address - Country:US
Mailing Address - Phone:225-928-1088
Mailing Address - Fax:225-932-9488
Practice Address - Street 1:1011 N BON MARCHE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2262
Practice Address - Country:US
Practice Address - Phone:225-928-1088
Practice Address - Fax:225-932-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA418251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health