Provider Demographics
NPI:1467980037
Name:DIMENSIONAL BEHAVIORAL HEALTH SERVICES INCORPORATION
Entity Type:Organization
Organization Name:DIMENSIONAL BEHAVIORAL HEALTH SERVICES INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PASSION
Authorized Official - Middle Name:LACOLE
Authorized Official - Last Name:TAYLOR PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-792-8448
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71309-1245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 JACKSON ST STE 111B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3000
Practice Address - Country:US
Practice Address - Phone:318-704-6515
Practice Address - Fax:318-704-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health