Organization
DEPARTMENT OF HEALTH AND HOSPITALS
Active
Other names
OBH-Ruston Addictive Disorders Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PHYLLIS JERRI PARKS MSW (OAD/REGIONAL ADMINISTRATOR)
(318) 362-3270
Entity
Organization
Contact information
Practice address
602 E GEORGIA AVE, RUSTON, LA 71270-3931
(318) 251-4125
(318) 251-5000
Mailing address
602 E GEORGIA AVE, RUSTON, LA 71270-3931
(318) 251-4125
(318) 251-5000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
880
LA
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC1223
LA
101YA0400X
Addiction (Substance Use Disorder) Counselor
RAC1224
LA
1041C0700X
Clinical Social Worker
Primary
LCSW 4518
LA
261QM1300X
Multi-Specialty Clinic/Center
MD010285
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H2376
BCBSLA
LA
Enumeration date
04/20/2006
Last updated
08/25/2010
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