Provider Demographics
NPI:1902191158
Name:BETA COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:BETA COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-929-6355
Mailing Address - Street 1:936 N BON MARCHE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2257
Mailing Address - Country:US
Mailing Address - Phone:225-929-6355
Mailing Address - Fax:225-929-6354
Practice Address - Street 1:936 N BON MARCHE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2257
Practice Address - Country:US
Practice Address - Phone:225-929-6355
Practice Address - Fax:225-929-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19221642544Medicaid
LA1154535581Medicare NSC