Provider Demographics
NPI:1386336485
Name:GAHARAN, PHILIP S (LAC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:GAHARAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-3327
Mailing Address - Country:US
Mailing Address - Phone:318-267-4355
Mailing Address - Fax:
Practice Address - Street 1:307 HAYES ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2531
Practice Address - Country:US
Practice Address - Phone:318-728-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1649101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)