Provider Demographics
NPI:1164082046
Name:ELMWOOD BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:ELMWOOD BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:504-450-9756
Mailing Address - Street 1:224 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-4039
Mailing Address - Country:US
Mailing Address - Phone:504-450-9756
Mailing Address - Fax:
Practice Address - Street 1:190 HICKORY AVE STE 8
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-4069
Practice Address - Country:US
Practice Address - Phone:504-313-4215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1679966139OtherNPI NUMBER FOR HEIDI HOLMES LPC