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2944 Ray Weiland Dr Baker LA 70714-3250 | |
| (225) 993-1535 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 2944 Ray Weiland Dr, Baker, Louisiana |
| Authorized Official Name and Position | Charmaine Stith (CEO) |
| Authorized Official Contact | 2259931535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2944 Ray Weiland Dr Baker LA 70714-3250 Ph: (225) 993-1535 | 2944 Ray Weiland Dr Baker LA 70714-3250 Ph: (225) 993-1535 |
| NPI Number | 1275049611 |
|---|---|
| Provider Enumeration Date | 12/21/2017 |
| Last Update Date | 10/18/2024 |
| Certification Date | 10/18/2024 |
| Medicare PECOS PAC ID | 8729511365 |
|---|---|
| Medicare Enrollment ID | O20241104002645 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275049611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 3594 (Louisiana) | Primary |
| 101YM0800X | Counselor - Mental Health | 3594 (Louisiana) | Secondary |
| 101YP1600X | Counselor - Pastoral | 3594 (Louisiana) | Secondary |
| Provider Name | Charmaine Lpc Stith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346533098 PECOS PAC ID: 2860925401 Enrollment ID: I20241104002938 |
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