Provider Demographics
NPI:1780958306
Name:CHILD&ADOLESCENT BEHAVIORAL HEALTH SYSTEM
Entity type:Organization
Organization Name:CHILD&ADOLESCENT BEHAVIORAL HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPPORT/CLERICAL
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-483-1985
Mailing Address - Street 1:3801 CANAL ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6069
Mailing Address - Country:US
Mailing Address - Phone:504-483-1985
Mailing Address - Fax:504-483-1984
Practice Address - Street 1:3801 CANAL ST STE 210
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6069
Practice Address - Country:US
Practice Address - Phone:504-483-1985
Practice Address - Fax:504-483-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization