Provider Demographics
NPI:1891466603
Name:BLUE SHEPHERD BEHAVIORAL SUPPORTS, LLC
Entity Type:Organization
Organization Name:BLUE SHEPHERD BEHAVIORAL SUPPORTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-543-4897
Mailing Address - Street 1:14036 RIVERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5513
Mailing Address - Country:US
Mailing Address - Phone:404-543-4897
Mailing Address - Fax:
Practice Address - Street 1:14036 RIVERLAKE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-5513
Practice Address - Country:US
Practice Address - Phone:404-543-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty