Basic Information
| Provider Information | |||||||||
| NPI: | 1669574851 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL MEDICINE AND ADDICTIVE DISORDERS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2910 EVANGELINE ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712013724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183885553 | ||||||||
| FaxNumber: | 3183882190 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 EVANGELINE ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712013724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183885553 | ||||||||
| FaxNumber: | 3183882190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3183885553 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD, LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 1926 | LA | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 261QR0405X | 343 | LA | X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 101YM0800X | 1926 | LA | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 1926 | LA | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.