IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY (NPI# 1952449118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952449118 |
| Entity Type | Organization |
| Organization Name | IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY |
| Other Organization Name | LAKE CHARLES BEHAVIORAL HEALTH CLINIC |
| Practice Address |
4105 Kirkman St Lake Charles LA 70607-4603 |
| Practice Telephone | 3374758022 |
| Practice Fax Number | 3374758054 |
| Mailing Telephone | 3374758022 |
| Mailing Fax Number | 3374758054 |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2016-09-12 |
| Authorized Official Name | MS. TANYA MCGEE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3374753100 |
| Authorized Official Credential | LAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
95 | LA | Allopathic & Osteopathic Physicians |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
95 | LA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1710041 | 05 |
| Other Name | Type Code |
|---|---|
| Lake Charles Behavioral Health Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457822751 | Imperial Calcasieu Human Services Authority | Clinic/Center | 2651 E Napoleon St, Sulphur, LA 70663 | 2018-12-12 |
| 1437522034 | Imperial Calcasieu Human Services Authority | Clinic/Center | 1211 N Cutting Ave, Jennings, LA 70546-4403 | 2015-11-04 |
| 1598245623 | Imperial Calcasieu Human Services Authority | Clinic/Center | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2018-08-17 |
| 1467844910 | Imperial Calcasieu Human Services Authority | Behavioral Analyst | 402 Industrial Dr, Oberlin, LA 70655-3519 | 2015-02-20 |
| 1457789802 | Imperial Calcasieu Human Services Authority | Clinic/Center | 3505 5th Ave, Suite C, Lake Charles, LA 70607-2156 | 2013-10-23 |
| 1902944184 | Imperial Calcasieu Human Services Authority | Clinic/Center | 106 W Port St, Deridder, LA 70634-4040 | 2007-02-01 |
| 1578601746 | Imperial Calcasieu Human Services Authority | Clinic/Center | 402 Industrial Dr, Oberlin, LA 70655-3519 | 2007-02-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY | 1 Lakeshore Dr # 2000, Lake Charles, LA 70629-0100 |
| Street Address |
4105 KIRKMAN ST |
| City | LAKE CHARLES |
| State | LA |
| Zip Code | 70607-4603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578517439 | Craig D. Waggoner | Psychologist | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2006-05-22 |
| 1659988343 | Katie Bruce | Pharmacist | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2020-09-26 |
| 1598245623 | Imperial Calcasieu Human Services Authority | Clinic/Center | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2018-08-17 |
| 1730698838 | Rebecca Becky Perry | Social Worker | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2017-09-21 |
| 1538566336 | Troy Barrow | Registered Nurse | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2014-11-24 |
| 1992101240 | Clint Dupre | Licensed Practical Nurse | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2014-11-14 |
| 1386057891 | Vicki Ann Lebleu | Nurse Practitioner | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2014-06-03 |
| 1750792248 | Genoa Healthcare, LLC | Pharmacy | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2014-05-19 |
| 1376971200 | Lexi Berryhill | Social Worker | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2013-11-01 |
| 1700127487 | Dana Young | Counselor | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2013-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710596283 | Dakota Loosemore | Student in an Organized Health Care Education/Training Program | 800 East Mcneese Street, Lake Charles, LA 70607 | 2020-07-30 |
| 1467003822 | Sarah Jane Walley | Specialist/Technologist | 800 E Mcneese Street, Lake Charles, LA 70607 | 2019-09-26 |
| 1770053902 | Antonio Rivera | Chiropractor | 2625 Dillard Loop, Suite C, Lake Charles, LA 70607 | 2018-11-30 |
| 1851861330 | Shannon Marie Melvin | Specialist/Technologist | 800 East Mcneese, Lake Charles, LA 70607 | 2018-11-28 |
| 1326517699 | Vincent Michael Williams | Specialist/Technologist | 800 East Mcneese St, Lake Charles, LA 70607 | 2018-11-16 |
| 1396263356 | Lake Area Physician Services LLC | Durable Medical Equipment & Medical Supplies | 10071 Hwy 385, Lake Charles, LA 70607 | 2017-08-30 |
| 1023556370 | Heath Bryan Coleman, Dds of Louisiana II, A Professional Dental LLC | Dentist | 2625 Dillard Loop, Ste A, Lake Charles, LA 70607 | 2017-02-07 |
| 1750741880 | Townsend Treatment Center, LLC | Substance Abuse Rehabilitation Facility | 635a Petro Point Dr, Lake Charles, LA 70607 | 2016-03-02 |
| 1194081414 | Clint Nickolas Lincoln | Family Medicine | 10071 Gulf Hwy, Lake Charles, LA 70607 | 2012-04-11 |
| 1295976652 | John Leroy Speer | Dentist | 3425 Louisiana Ave., Lake Charles, LA 70607 | 2009-03-16 |
| Find all providers in zip 70607 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477177814 | Dr. Phaetra K. Raney Foundation Inc. | Clinic/Center | 1 Lakeshore Dr Ste 130, Lake Charles, LA 70629-0100 | 2020-06-02 |
| 1699270843 | All About You Home Healthcare Inc | Clinic/Center | 3109 Common St Ste 100, Lake Charles, LA 70601-8575 | 2018-03-29 |
| 1730340316 | Vcphcs Vi, LLC | Clinic/Center | 2829 4th Ave Ste 200, Lake Charles, LA 70601-7834 | 2008-06-17 |
| 1841300225 | Resource Management Services, Inc. of Southwest Louisiana | Clinic/Center | 1333 Common St, Lake Charles, LA 70601-5255 | 2006-08-30 |
| 1366433278 | Bridgeway Psychiatric Center, Inc. | Clinic/Center | 3451 5th Ave, Suite A, Lake Charles, LA 70607-2127 | 2005-10-31 |
| 1902423668 | Gracious Words Counseling, LLC | Clinic/Center | 465 Derby Dr, Lake Charles, LA 70615-4860 | 2020-06-29 |
| 1437621984 | Live Oak Counseling, LLC | Clinic/Center | 748 Bayou Pines East Dr Ste B, Lake Charles, LA 70601-7596 | 2018-12-21 |
| 1598245623 | Imperial Calcasieu Human Services Authority | Clinic/Center | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2018-08-17 |
| 1275012239 | Mindful Wellness,llc | Clinic/Center | 977 Baywood Dr, Lake Charles, LA 70611-6817 | 2018-08-10 |
| 1457767980 | Family Bridges Counseling Center, LLC | Clinic/Center | 748 Bayou Pines East Dr, Ste B, Lake Charles, LA 70601-7184 | 2014-07-04 |
| Find all providers in LAKE CHARLES | ||||
| City | LAKE CHARLES |
| Zip Code | 70607 |
Please comment or provide details below to improve the information on IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.