Provider Demographics
NPI:1154414035
Name:LIBERTY HEALTH ASSOCIATES, LLC
Entity type:Organization
Organization Name:LIBERTY HEALTH ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-766-2262
Mailing Address - Street 1:8116 ONE CALAIS AVE
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3409
Mailing Address - Country:US
Mailing Address - Phone:225-766-2262
Mailing Address - Fax:225-766-2263
Practice Address - Street 1:8116 ONE CALAIS AVE
Practice Address - Street 2:SUITE 1-C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3409
Practice Address - Country:US
Practice Address - Phone:225-766-2262
Practice Address - Fax:225-766-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA194694Medicare ID - Type UnspecifiedPROVIDER NUMBER