Provider Demographics
NPI:1942758487
Name:APPLEGATE RECOVERY OF MONROE, LLC
Entity type:Organization
Organization Name:APPLEGATE RECOVERY OF MONROE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-742-0500
Mailing Address - Street 1:1605 BENTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3579
Mailing Address - Country:US
Mailing Address - Phone:318-742-0500
Mailing Address - Fax:318-742-0588
Practice Address - Street 1:3001 ARMAND ST STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3761
Practice Address - Country:US
Practice Address - Phone:318-600-3687
Practice Address - Fax:318-600-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder