Provider Demographics
NPI:1093195141
Name:GENESIS BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GENESIS BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:225-771-9980
Mailing Address - Street 1:11835 BRICKSOME AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8714 JEFFERSON HWY STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2002
Practice Address - Country:US
Practice Address - Phone:225-276-8428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2810101YM0800X
273R00000X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No273R00000XHospital UnitsPsychiatric Unit