Provider Demographics
NPI:1528402922
Name:CADDO BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CADDO BEHAVIORAL HEALTH SERVICES
Other - Org Name:CBH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-884-4205
Mailing Address - Street 1:195 COLONEL AP KOUNS DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2977
Mailing Address - Country:US
Mailing Address - Phone:318-884-4205
Mailing Address - Fax:
Practice Address - Street 1:195 COLONEL AP KOUNS DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2977
Practice Address - Country:US
Practice Address - Phone:318-884-4205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health