Provider Demographics
NPI:1306020698
Name:BIOBEHAVIORAL MEDICINE COMPANY, LLC
Entity Type:Organization
Organization Name:BIOBEHAVIORAL MEDICINE COMPANY, LLC
Other - Org Name:BIOBEHAVIORAL MEDICINE CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:KENISON
Authorized Official - Last Name:ROY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:504-780-2766
Mailing Address - Street 1:4933 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1031
Mailing Address - Country:US
Mailing Address - Phone:504-780-2766
Mailing Address - Fax:504-780-9699
Practice Address - Street 1:4933 WABASH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1031
Practice Address - Country:US
Practice Address - Phone:504-780-2766
Practice Address - Fax:504-780-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 207K00000X, 2084A0401X
LAMD0120782084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty