Provider Demographics
NPI:1588910947
Name:POST TRAUMA INSTITUTE OF LOUISIANA
Entity type:Organization
Organization Name:POST TRAUMA INSTITUTE OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:SULLIVAN
Authorized Official - Last Name:SALONE
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-751-5412
Mailing Address - Street 1:PO BOX 83814
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-3814
Mailing Address - Country:US
Mailing Address - Phone:225-751-5412
Mailing Address - Fax:225-751-5847
Practice Address - Street 1:10512 S GLENSTONE PL
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2966
Practice Address - Country:US
Practice Address - Phone:225-751-5412
Practice Address - Fax:225-751-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4245101YP2500X
101YP2500X, 261QM0850X, 261QM0801X
LA0304103TC0700X
LAMPAP 000015103TP0016X
LA105541041C0700X
LA19D2061587291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2385372Medicaid