Provider Demographics
NPI:1033598784
Name:DIVINE TOUCH BEHAVIORAL HEALTH CENTER LLC
Entity Type:Organization
Organization Name:DIVINE TOUCH BEHAVIORAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARONYA
Authorized Official - Middle Name:ALEISHA
Authorized Official - Last Name:BATES-CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-372-7589
Mailing Address - Street 1:804 N 31ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3945
Mailing Address - Country:US
Mailing Address - Phone:318-807-4058
Mailing Address - Fax:318-807-4057
Practice Address - Street 1:804 N 31ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3945
Practice Address - Country:US
Practice Address - Phone:318-807-4058
Practice Address - Fax:318-807-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health