Provider Demographics
NPI:1639944861
Name:GENESIS BEHAVIORAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:GENESIS BEHAVIORAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:808-295-2985
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-0253
Mailing Address - Country:US
Mailing Address - Phone:808-295-2985
Mailing Address - Fax:
Practice Address - Street 1:2401 W 65TH ST RM 220
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3207
Practice Address - Country:US
Practice Address - Phone:808-295-2985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty