Organization
JENNINGS BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY GAUDET (MGR SULPHUR OUTPATIENT CLINIC)
(337) 527-7878
Entity
Organization
Contact information
Practice address
110 E DARBONNE ST, SULPHUR, LA 70663-4958
(337) 527-7878
(337) 527-7880
Mailing address
110 E DARBONNE ST, SULPHUR, LA 70663-4958
(337) 527-7878
(337) 527-7880
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1055
LA
1041C0700X
Clinical Social Worker
8971
LA
2084P0800X
Psychiatry Physician
021615
LA
208D00000X
General Practice Physician
014484R
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP 05359
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1949744
—
LA
01
—
5C425
MEDICARE
LA
Enumeration date
10/15/2008
Last updated
10/15/2008
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