Provider Demographics
NPI:1093049280
Name:LIFENET BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:LIFENET BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:EHRETT
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-246-2600
Mailing Address - Street 1:4070 LONESOME RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7085
Mailing Address - Country:US
Mailing Address - Phone:985-246-2600
Mailing Address - Fax:985-246-2601
Practice Address - Street 1:4070 LONESOME RD
Practice Address - Street 2:SUITE B
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7085
Practice Address - Country:US
Practice Address - Phone:985-246-2600
Practice Address - Fax:985-246-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0207502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty