Provider Demographics
NPI:1083892012
Name:LL&S BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:LL&S BEHAVIORAL HEALTH SERVICES
Other - Org Name:TODD A. LARK, SR.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LARK, SR
Authorized Official - Suffix:SR
Authorized Official - Credentials:CSW
Authorized Official - Phone:615-573-9089
Mailing Address - Street 1:935 CONTESSA DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4276
Mailing Address - Country:US
Mailing Address - Phone:615-573-9089
Mailing Address - Fax:615-868-4477
Practice Address - Street 1:935 CONTESSA DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4276
Practice Address - Country:US
Practice Address - Phone:615-573-9089
Practice Address - Fax:615-868-4477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LL&S BEHAVIORAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-31
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000189998251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1503964Medicaid