Provider Demographics
NPI:1265984082
Name:BEHAVIROAL HEALTH &WELLNESS LLC
Entity type:Organization
Organization Name:BEHAVIROAL HEALTH &WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPST/PSR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:DELAUNE
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-789-0975
Mailing Address - Street 1:302 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3942
Mailing Address - Country:US
Mailing Address - Phone:985-732-2089
Mailing Address - Fax:985-516-3931
Practice Address - Street 1:302 RICHMOND STREET SUITE A
Practice Address - Street 2:
Practice Address - City:BOGALOUSA
Practice Address - State:LA
Practice Address - Zip Code:70427
Practice Address - Country:US
Practice Address - Phone:985-732-2089
Practice Address - Fax:985-516-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1033588793251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health