Provider Demographics
NPI:1801257795
Name:INDEPENDENT BEHAVIORAL MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:INDEPENDENT BEHAVIORAL MENTAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:SOFIA
Authorized Official - Last Name:BEGAULT
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:504-275-7489
Mailing Address - Street 1:1385 S RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1022
Mailing Address - Country:US
Mailing Address - Phone:888-214-4264
Mailing Address - Fax:
Practice Address - Street 1:1385 S RIDGE DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-1022
Practice Address - Country:US
Practice Address - Phone:888-214-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty