Provider Demographics
NPI:1538445176
Name:YOUTH SERVICE BUREAU OF ST TAMMANY
Entity type:Organization
Organization Name:YOUTH SERVICE BUREAU OF ST TAMMANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-893-2570
Mailing Address - Street 1:430 N NEW HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2830
Mailing Address - Country:US
Mailing Address - Phone:985-893-2570
Mailing Address - Fax:985-893-2758
Practice Address - Street 1:430 N NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2830
Practice Address - Country:US
Practice Address - Phone:985-893-2570
Practice Address - Fax:985-893-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA194251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1434019Medicaid