Basic Information
| Provider Information | |||||||||
| NPI: | 1003135138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITOL CLINICAL & FORENSIC PSYCHIATRY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5261 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708086547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252429221 | ||||||||
| FaxNumber: | 8888173026 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 L S U AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252429221 | ||||||||
| FaxNumber: | 8888173026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 02/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEBOURGEOIS | ||||||||
| AuthorizedOfficialFirstName: | HERBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST/MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2252429221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084F0202X | 025396 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry |
No ID Information.