Basic Information
| Provider Information | |||||||||
| NPI: | 1851834527 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEEDLINKS BEHAVIOR MGMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 NORTH MARKET SUITE C-104 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186265597 | ||||||||
| FaxNumber: | 3186265691 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 NORTH MARKET SUITE C-104 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186265597 | ||||||||
| FaxNumber: | 3186265691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2016 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR / PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3187719806 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NONE | ||||||||
| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 2203782947 | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.