Provider Demographics
NPI:1295242394
Name:GENESYS ONE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:GENESYS ONE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEQUOIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC, ADC
Authorized Official - Phone:903-669-9285
Mailing Address - Street 1:2642 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4847
Mailing Address - Country:US
Mailing Address - Phone:903-706-3083
Mailing Address - Fax:
Practice Address - Street 1:2642 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4847
Practice Address - Country:US
Practice Address - Phone:903-706-3083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUOIA BROWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-10
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX72961261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200449000BMedicaid