| Street Smart Recovery Llc | |
|
11606 Southfork Ave Baton Rouge LA 70816-5235 | |
| (225) 439-7255 | |
| Not Available |
| Full Name | Street Smart Recovery Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 11606 Southfork Ave, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Jeff Raybon (MEMBER MANAGER) |
| Authorized Official Contact | 2254397255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Street Smart Recovery Llc 12602 Coursey Blvd Baton Rouge LA 70816-4555 Ph: (225) 439-7255 | Street Smart Recovery Llc 11606 Southfork Ave Baton Rouge LA 70816-5235 Ph: (225) 439-7255 |
| NPI Number | 1518509579 |
|---|---|
| Provider Enumeration Date | 10/11/2019 |
| Last Update Date | 10/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518509579 | NPI | - | NPPES |
| 101YA0400X | Other | LA | TAXONOMY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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