Provider Demographics
NPI:1710352398
Name:VIOLET BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:VIOLET BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AND OWNER/ REGISTERED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATRICE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-373-0373
Mailing Address - Street 1:4905 E JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-4001
Mailing Address - Country:US
Mailing Address - Phone:504-373-0373
Mailing Address - Fax:
Practice Address - Street 1:4905 E JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-4001
Practice Address - Country:US
Practice Address - Phone:504-373-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42086102K103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty