Provider Demographics
NPI:1396113106
Name:LOUISIANA ADDICTION AND WELLNESS LLC
Entity type:Organization
Organization Name:LOUISIANA ADDICTION AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-3200
Mailing Address - Street 1:11505 PERKINS RD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-9103
Mailing Address - Country:US
Mailing Address - Phone:225-767-3200
Mailing Address - Fax:225-767-6811
Practice Address - Street 1:11505 PERKINS RD
Practice Address - Street 2:BUILDING 1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-9103
Practice Address - Country:US
Practice Address - Phone:225-767-3200
Practice Address - Fax:225-767-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00917746261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)