Provider Demographics
NPI:1952594814
Name:FREE INDEED INTENSIVE OUTPATIENT CLINIC
Entity Type:Organization
Organization Name:FREE INDEED INTENSIVE OUTPATIENT CLINIC
Other - Org Name:SET FREE INDEED, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TONJA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-924-1910
Mailing Address - Street 1:2414 BUNKER HILL DR STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3303
Mailing Address - Country:US
Mailing Address - Phone:225-924-1910
Mailing Address - Fax:
Practice Address - Street 1:2414 BUNKER HILL DR STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3303
Practice Address - Country:US
Practice Address - Phone:225-924-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA315261QM0855X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health