| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 350 Main St, Baker, Louisiana |
| Authorized Official Name and Position | Taja R Hamilton (DIRECTOR) |
| Authorized Official Contact | 2257786783 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
350 Main St Baker LA 70714-3767 Ph: (225) 778-6783 | 350 Main St Baker LA 70714-3767 Ph: (225) 778-6783 |
| NPI Number | 1528463064 |
|---|---|
| Provider Enumeration Date | 10/27/2014 |
| Last Update Date | 06/14/2023 |
| Certification Date | 06/14/2023 |
| Medicare PECOS PAC ID | 6901337120 |
|---|---|
| Medicare Enrollment ID | O20241016000498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528463064 | NPI | - | NPPES |
| Provider Name | Detrica Freeman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821538158 PECOS PAC ID: 8325570351 Enrollment ID: I20241016000730 |
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