Provider Demographics
NPI:1255369823
Name:PRIORITY BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:PRIORITY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:CHANTELLE
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:337-367-7889
Mailing Address - Street 1:PO BOX 13904
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-3904
Mailing Address - Country:US
Mailing Address - Phone:337-367-7889
Mailing Address - Fax:337-359-8580
Practice Address - Street 1:115 HANSEL ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-5039
Practice Address - Country:US
Practice Address - Phone:337-367-7889
Practice Address - Fax:337-359-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1119369251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1119369Medicaid
LA1119369Medicaid