Provider Demographics
NPI:1881969210
Name:NATCHITOCHES BEHAVIORAL HEALTH CLINIC
Entity type:Organization
Organization Name:NATCHITOCHES BEHAVIORAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED ADDICTIONS COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHAWNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:318-357-3122
Mailing Address - Street 1:210 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6052
Mailing Address - Country:US
Mailing Address - Phone:318-357-3122
Mailing Address - Fax:318-357-3240
Practice Address - Street 1:210 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6052
Practice Address - Country:US
Practice Address - Phone:318-357-3122
Practice Address - Fax:318-357-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1288302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization