Basic Information
| Provider Information | |||||||||
| NPI: | 1730104654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL AREA HUMAN SERVICES DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASCENSION BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 66558 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708966558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259222700 | ||||||||
| FaxNumber: | 2253625319 | ||||||||
| Practice Location | |||||||||
| Address1: | 1056 E WORTHY ST STE B | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707374369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256215770 | ||||||||
| FaxNumber: | 2256443208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LAUGHINGHOUSE | ||||||||
| AuthorizedOfficialFirstName: | JANZLEAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2259222700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CAPITAL AREA HUMAN SERVICES DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHD, LCSW-BACS, LAC | ||||||||
| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 1541851 | 05 | LA | MEDICAID |