Basic Information
| Provider Information | |||||||||
| NPI: | 1649421736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPTIONS FOR INDEPENDENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 761 W TUNNEL BLVD STE D | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703605544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858682620 | ||||||||
| FaxNumber: | 9858688547 | ||||||||
| Practice Location | |||||||||
| Address1: | 1340 W TUNNEL BLVD STE 212 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703602818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858538550 | ||||||||
| FaxNumber: | 9858538559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | GLEASON | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9858538550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 10220 | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.