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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YA0400X
TAXONOMY
LA
Enumeration date
10/11/2019
Last updated
10/11/2019
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