Organization
DEPARTMENT OF HEALTH AND HOSPITALS
Active
Other names
OBH-Bastrop Addictive Disorders Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHYLLIS JERRI PARKS MSW (OAD/REGIONAL ADMINISTRATOR)
(318) 362-3270
Entity
Organization
Contact information
Practice address
320 S FRANKLIN ST, BASTROP, LA 71220-4539
(318) 283-0868
(318) 283-0875
Mailing address
320 S FRANKLIN ST, BASTROP, LA 71220-4539
(318) 283-0868
(318) 283-0875
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LAC1076
LA
101YA0400X
Addiction (Substance Use Disorder) Counselor
RAC1081
LA
261QM1300X
Multi-Specialty Clinic/Center
MD014425
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G3195
BCBS
LA
Enumeration date
04/20/2006
Last updated
08/25/2010
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