Provider Demographics
NPI:1790236586
Name:HOLISTIC BEHAVIORAL HEALTH SERVICES OF LOUISIANA
Entity Type:Organization
Organization Name:HOLISTIC BEHAVIORAL HEALTH SERVICES OF LOUISIANA
Other - Org Name:HOLISTIC BEHAVIORAL HEALTH SERVICE OF LOUISIANA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMIE
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-371-2945
Mailing Address - Street 1:2156 WOODDALE BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1404
Mailing Address - Country:US
Mailing Address - Phone:225-371-2945
Mailing Address - Fax:225-930-8059
Practice Address - Street 1:2156 WOODDALE BLVD STE 750
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1404
Practice Address - Country:US
Practice Address - Phone:225-371-2945
Practice Address - Fax:225-930-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 252Y00000X, 261QM0801X, 323P00000X
LA510417251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility