Basic Information
| Provider Information | |||||||||
| NPI: | 1215365689 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEHAVIORAL SERVICES OF LOUISIANA, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 816 BENTON RD | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711113744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187423408 | ||||||||
| FaxNumber: | 2259299740 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 SAINT TAMMANY ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708066064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259295738 | ||||||||
| FaxNumber: | 2259299740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2013 | ||||||||
| LastUpdateDate: | 10/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | BLONDEAU | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/AGENT OF SERVICE | ||||||||
| AuthorizedOfficialTelephone: | 2252932700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BCM HOLDINGS, L.L.C. | ||||||||
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| AuthorizedOfficialCredential: | J.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.