Tara Pitre Gordon
Individual provider Active NPI Case Manager/Care Coordinator · Grand Couteau, LA
NPI 1578033866 · NPPES record last updated Feb 28, 2021
Key facts
- NPI
- 1578033866
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- License
- 005670607 (LA)
- Practice address
- 123 Church Street
Grand Couteau, LA 70541 - Phone
- (337) 662-3737
- Fax
- (337) 662-3636
- NPI assigned
- Nov 28, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CIT5128 | LA | MD | Addiction (Substance Use Disorder) Counselor |
| 005670607 | LA | MD | Case Manager/Care Coordinator |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CIT5128 | LA | |
| Case Manager/Care Coordinator | 171M00000X | 005670607 | LA | Yes |
Addresses
Primary practice location
123 Church Street
Grand Couteau, LA 70541
Mailing address
11861 Coursey Blvd
Baton Rouge, LA 70816-4404
Phone (225) 612-8656
Other practice location 1
11861 Coursey Blvd
Baton Rouge, LA 70816-4404
Phone (225) 612-8656
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.