Basic Information
| Provider Information | |||||||||
| NPI: | 1508883547 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEPT OF HEALTH & HOSPITALS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | PLAQUEMINES BEHAVIORAL HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3708 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELLE CHASSE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700373002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043935624 | ||||||||
| FaxNumber: | 5043935633 | ||||||||
| Practice Location | |||||||||
| Address1: | 3708 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELLE CHASSE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700373002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043935624 | ||||||||
| FaxNumber: | 5043935633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MAGEE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OAD FACILITY MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5043935624 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.ED. LPC, NCC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 160 | LA | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 1800 | LA | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 2953 | LA | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 3104A0630X | RN072847 | LA | X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
No ID Information.