| NPI | 1174589022 |
|---|---|
| Doing Business As | OBH-BASTROP ADDICTIVE DISORDERS CLINIC |
| Entity Type | Organization |
| Authorized Contact | PHYLLIS JERRI PARKS Oad/Regional Administrator 318-362-3270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA LAC1076) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA RAC1081) |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: LA MD014425) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2010-08-25 |