Provider Demographics
NPI:1073876934
Name:AXIS ONE BEHAVIORAL SOLUTIONS A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AXIS ONE BEHAVIORAL SOLUTIONS A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:AXIS ONE BEHAVIORAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:MAJID
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-875-2379
Mailing Address - Street 1:4401 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5340
Mailing Address - Country:US
Mailing Address - Phone:504-875-2379
Mailing Address - Fax:504-264-5590
Practice Address - Street 1:4401 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5340
Practice Address - Country:US
Practice Address - Phone:504-875-2379
Practice Address - Fax:504-264-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-16
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA88751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty