Provider Demographics
NPI:1417563370
Name:SOUTHERN LOUISIANA BEHAVIOR CONSULTANTS LLC
Entity Type:Organization
Organization Name:SOUTHERN LOUISIANA BEHAVIOR CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-552-6767
Mailing Address - Street 1:100 HARTON RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6386
Mailing Address - Country:US
Mailing Address - Phone:337-552-6767
Mailing Address - Fax:
Practice Address - Street 1:111 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3817
Practice Address - Country:US
Practice Address - Phone:337-270-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty