Provider Demographics
NPI:1891947479
Name:JENNINGS BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:JENNINGS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR SULPHUR OUTPATIENT CLINIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-527-7878
Mailing Address - Street 1:110 E DARBONNE ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-4958
Mailing Address - Country:US
Mailing Address - Phone:337-527-7878
Mailing Address - Fax:337-527-7880
Practice Address - Street 1:110 E DARBONNE ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-4958
Practice Address - Country:US
Practice Address - Phone:337-527-7878
Practice Address - Fax:337-527-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1055103T00000X
LA89711041C0700X
LA0216152084P0800X
LA014484R208D00000X
LAAP 05359363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C425OtherMEDICARE
LA1949744Medicaid