Provider Demographics
NPI:1851834527
Name:SEEDLINKS BEHAVIOR MGMT
Entity Type:Organization
Organization Name:SEEDLINKS BEHAVIOR MGMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-771-9806
Mailing Address - Street 1:1500 NORTH MARKET SUITE C-104
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107
Mailing Address - Country:US
Mailing Address - Phone:318-626-5597
Mailing Address - Fax:318-626-5691
Practice Address - Street 1:1500 NORTH MARKET SUITE C-104
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107
Practice Address - Country:US
Practice Address - Phone:318-626-5597
Practice Address - Fax:318-626-5691
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203782947251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health