Provider Demographics
NPI:1326405499
Name:BETA
Entity Type:Organization
Organization Name:BETA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FFT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SINEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-315-3594
Mailing Address - Street 1:936 N BON MARCHE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2257
Mailing Address - Country:US
Mailing Address - Phone:225-929-6355
Mailing Address - Fax:
Practice Address - Street 1:936 N BON MARCHE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2257
Practice Address - Country:US
Practice Address - Phone:225-929-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA721436134251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health