Change of Address, Key Personnel, or Name

Providers licensed by Health Standards Section (HSS) must notify the appropriate department of any changes regarding the facility: name, email address, phone or fax number and pay associated fees.

Notification shall be in writing, on facility or agency letterhead and sent to:

Health Standards Section
Attn: Program Desk (Insert Name of Program)
P.O. Box 3767
Baton Rouge, LA 70821

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Change of Address

• COA Checklist for Behavioral Health Service Providers. Print and follow.
• Providers licensed by Health Standards Section (HSS) must notify the department of a change of address.
• All providers requesting a change of address shall submit a Letter of Intent indicating the effective date of change. 

Key Personnel Change

• A change in key personnel, such as the Administrator, requires the provider to notify HSS in order for the provider's records to be updated. 
• All communications regarding the agency will be directed to the Administrator.
• Notification shall be made using the  HSS Key Personnel Change Form.

Name Change 

• A change in the name of the licensed provider requires HSS to be notified.
• The provider shall submit a new license application showing the transaction being requested is a name change.
• A fee of $25 will be required to print a new license.
• Please contact the appropriate Program Desk at 225-342-0138 for additional information.