Provider Demographics
NPI:1700156866
Name:START CORPORATION
Entity Type:Organization
Organization Name:START CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-BACS
Authorized Official - Phone:985-879-3966
Mailing Address - Street 1:420 MAGNOLIA ST
Mailing Address - Street 2:P.O. BOX 165
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6304
Mailing Address - Country:US
Mailing Address - Phone:985-879-3966
Mailing Address - Fax:985-872-4473
Practice Address - Street 1:420 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6304
Practice Address - Country:US
Practice Address - Phone:985-879-3966
Practice Address - Fax:985-872-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X, 261QC1500X, 261QM0801X
LA251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2347951Medicaid