Provider Demographics
NPI:1790315158
Name:BEHAVIORAL SERVICES OF LOUISIANA
Entity Type:Organization
Organization Name:BEHAVIORAL SERVICES OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSS
Authorized Official - Prefix:
Authorized Official - First Name:DIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-296-4802
Mailing Address - Street 1:320 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-5121
Mailing Address - Country:US
Mailing Address - Phone:504-296-4802
Mailing Address - Fax:
Practice Address - Street 1:8326 KELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4803
Practice Address - Country:US
Practice Address - Phone:504-296-8602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care