Provider Demographics
NPI:1518153139
Name:TRINITY BEHAVIORAL HEALTH OF PORT ALLEN
Entity Type:Organization
Organization Name:TRINITY BEHAVIORAL HEALTH OF PORT ALLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:WYATT
Authorized Official - Last Name:EDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-389-5837
Mailing Address - Street 1:2753 COURT STREET
Mailing Address - Street 2:UNIT C & D
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2509
Mailing Address - Country:US
Mailing Address - Phone:225-389-5837
Mailing Address - Fax:225-389-5836
Practice Address - Street 1:2753 COURT STREET
Practice Address - Street 2:UNIT C
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767
Practice Address - Country:US
Practice Address - Phone:225-389-5837
Practice Address - Fax:225-389-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization