Basic Information
| Provider Information | |||||||||
| NPI: | 1104176825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEYOND WORDS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1409 KIRKMAN ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706015344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374193586 | ||||||||
| FaxNumber: | 8552399737 | ||||||||
| Practice Location | |||||||||
| Address1: | 1409 KIRKMAN ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706015344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374193586 | ||||||||
| FaxNumber: | 8552399737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2012 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | LAKISHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 3374193586 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD, MP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TP0016X | MP.0018 | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) |
No ID Information.