Provider Demographics
NPI:1295065241
Name:JOURNEY BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:JOURNEY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-528-7992
Mailing Address - Street 1:423 CYPRESS ST.
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663
Mailing Address - Country:US
Mailing Address - Phone:337-528-7992
Mailing Address - Fax:337-528-7994
Practice Address - Street 1:423 CYPRESS ST.
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663
Practice Address - Country:US
Practice Address - Phone:337-528-7992
Practice Address - Fax:337-528-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2176103T00000X
LA89711041C0700X
LA0216152084P0800X
2084P0800X, 104100000X, 103T00000X
LA05359364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1815713Medicaid