Provider Demographics
NPI:1578610275
Name:ABOVE & BEYOND CARE PROFESSIONALS LLC
Entity Type:Organization
Organization Name:ABOVE & BEYOND CARE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-934-1919
Mailing Address - Street 1:1305 DELHI ST
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4626
Mailing Address - Country:US
Mailing Address - Phone:318-934-1919
Mailing Address - Fax:318-934-1921
Practice Address - Street 1:1305 DELHI ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4626
Practice Address - Country:US
Practice Address - Phone:318-934-1919
Practice Address - Fax:318-934-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1161021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1161021Medicaid
LA4504951OtherEMC PERMITTER NUMBER