Provider Demographics
NPI:1295360154
Name:NEW BEGINNINGS BEHAVIOR SERVICES, LLC
Entity Type:Organization
Organization Name:NEW BEGINNINGS BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BOUDLOCHE
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCBA, LPC-S
Authorized Official - Phone:318-376-4425
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:SWARTZ
Mailing Address - State:LA
Mailing Address - Zip Code:71281-0569
Mailing Address - Country:US
Mailing Address - Phone:318-376-4425
Mailing Address - Fax:318-515-0014
Practice Address - Street 1:104 COPPER RUN DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4017
Practice Address - Country:US
Practice Address - Phone:318-376-4425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2349376Medicaid