Basic Information
| Provider Information | |||||||||
| NPI: | 1679873004 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AUDUBON BEHAVIORAL HEALTHCARE OF LUFKIN LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 757 PROFESSIONAL DR N | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187976785 | ||||||||
| FaxNumber: | 3187976986 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 GOBBLERS KNOB RD | ||||||||
| Address2: | |||||||||
| City: | LUFKIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759045419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187976785 | ||||||||
| FaxNumber: | 3187976986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2010 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | BILL | ||||||||
| AuthorizedOfficialMiddleName: | VANN | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER OF LP | ||||||||
| AuthorizedOfficialTelephone: | 3187976785 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.