| Imperial Calcasieu Hsa Behavioral Health Beauregard | |
|
106 W Port St Deridder LA 70634-4040 | |
| (337) 462-1641 | |
| (337) 462-1354 |
| Full Name | Imperial Calcasieu Hsa Behavioral Health Beauregard |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 106 W Port St, Deridder, Louisiana |
| Authorized Official Name and Position | Nikyia Brown (CREDENTIALING SPEC.) |
| Authorized Official Contact | 3374753100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imperial Calcasieu Hsa Behavioral Health Beauregard 106 W Port St Deridder LA 70634-4040 Ph: (337) 462-1641 | Imperial Calcasieu Hsa Behavioral Health Beauregard 106 W Port St Deridder LA 70634-4040 Ph: (337) 462-1641 |
| NPI Number | 1902944184 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 09/19/2024 |
| Certification Date | 09/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902944184 | NPI | - | NPPES |
| 1750069 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 80 (Louisiana) | Primary |
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