Basic Information
| Provider Information | |||||||||
| NPI: | 1467844910 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALLEN BEHAVIORAL HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4105 KIRKMAN ST | ||||||||
| Address2: | LAKE CHARLES | ||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706074603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374758022 | ||||||||
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| Practice Location | |||||||||
| Address1: | 402 INDUSTRIAL DR | ||||||||
| Address2: | |||||||||
| City: | OBERLIN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706553519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3376393001 | ||||||||
| FaxNumber: | 3376393008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2015 | ||||||||
| LastUpdateDate: | 02/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | MILLS | ||||||||
| AuthorizedOfficialFirstName: | JENNY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIORAL HEALTH DIVISION DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3374758022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 177 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.