Provider Demographics
NPI:1760733539
Name:WINGS OF EAGLES BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:WINGS OF EAGLES BEHAVIORAL HEALTH
Other - Org Name:TERRY DRISKILL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISKILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-737-2566
Mailing Address - Street 1:201 PINE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:LA
Mailing Address - Zip Code:71226-7904
Mailing Address - Country:US
Mailing Address - Phone:318-737-2566
Mailing Address - Fax:318-933-7385
Practice Address - Street 1:201 PINE BLUFF RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:LA
Practice Address - Zip Code:71226-7904
Practice Address - Country:US
Practice Address - Phone:318-737-2566
Practice Address - Fax:318-933-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3601OtherTERRY DRISKILL