Provider Demographics
NPI:1528725454
Name:STITCHES FOR LIFE INC
Entity type:Organization
Organization Name:STITCHES FOR LIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:BLUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:225-892-4938
Mailing Address - Street 1:11616 SOUTHFORK AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5241
Mailing Address - Country:US
Mailing Address - Phone:225-955-4971
Mailing Address - Fax:
Practice Address - Street 1:11616 SOUTHFORK AVE STE 400
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5241
Practice Address - Country:US
Practice Address - Phone:225-955-4971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health