Provider Demographics
NPI:1861925729
Name:COGNITIVE DEVELOPMENT CENTER OF SEASIDE HEALTHCARE
Entity type:Organization
Organization Name:COGNITIVE DEVELOPMENT CENTER OF SEASIDE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHP
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-537-6776
Mailing Address - Street 1:3821 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-3146
Mailing Address - Country:US
Mailing Address - Phone:985-537-6776
Mailing Address - Fax:985-537-6779
Practice Address - Street 1:3821 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-3146
Practice Address - Country:US
Practice Address - Phone:985-537-6776
Practice Address - Fax:985-537-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13909251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health