Provider Demographics
NPI:1568509255
Name:NORTHWEST LOUISIANA BEHAVIORAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:NORTHWEST LOUISIANA BEHAVIORAL HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-676-5111
Mailing Address - Street 1:6201 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:LOT 870
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-5056
Mailing Address - Country:US
Mailing Address - Phone:318-688-6441
Mailing Address - Fax:
Practice Address - Street 1:1310 N HEARNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6516
Practice Address - Country:US
Practice Address - Phone:318-676-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty