Provider Demographics
NPI:1184990517
Name:EDUCATIONAL AND TREATMENT COUNCIL, INC.
Entity type:Organization
Organization Name:EDUCATIONAL AND TREATMENT COUNCIL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-433-1062
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-0864
Mailing Address - Country:US
Mailing Address - Phone:337-433-1062
Mailing Address - Fax:
Practice Address - Street 1:2400 MERGANSER ST
Practice Address - Street 2:BUILDING B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-6898
Practice Address - Country:US
Practice Address - Phone:337-433-1062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2347251S00000X
LA14681251B00000X
LA039251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management