Basic Information
| Provider Information | |||||||||
| NPI: | 1063492320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEBLIN HEALTH CONCEPTS & ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 FEU FOLLET RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705084234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136869194 | ||||||||
| FaxNumber: | 7136869413 | ||||||||
| Practice Location | |||||||||
| Address1: | 4411 DACOMA ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770928611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136869194 | ||||||||
| FaxNumber: | 7136869413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7136869194 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 251B00000X | N | Agencies | Case Management | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 109338701 | 05 | TX | MEDICAID | 109338702 | 05 | TX | MEDICAID | 109338705 | 05 | TX | MEDICAID | 141440101 | 05 | TX | MEDICAID | 109338704 | 05 | TX | MEDICAID | 425288401 | 05 | TX | MEDICAID | 386563601 | 05 | TX | MEDICAID |