Provider Demographics
NPI:1740503952
Name:ST NICHOLAS CENTER FOR EARLY INTERVENTION
Entity type:Organization
Organization Name:ST NICHOLAS CENTER FOR EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF BOARD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-656-2561
Mailing Address - Street 1:519 CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5205
Mailing Address - Country:US
Mailing Address - Phone:337-656-2561
Mailing Address - Fax:337-656-2562
Practice Address - Street 1:343 BROAD ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4223
Practice Address - Country:US
Practice Address - Phone:337-656-2561
Practice Address - Fax:337-656-2562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty