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Organization
STREET SMART RECOVERY LLC
Active
Organization
STREET SMART RECOVERY LLC
Active
Other names
STREET SMART RECOVERY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF RAYBON (MEMBER MANAGER)
(225) 439-7255
Entity
Organization
Contact information
Practice address
11606 SOUTHFORK AVE, BATON ROUGE, LA 70816-5235
(225) 439-7255
Mailing address
12602 COURSEY BLVD, BATON ROUGE, LA 70816-4555
(225) 439-7255
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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