Healthcare Provider Details

I. General information

NPI: 1801106638
Provider Name (Legal Business Name): DHH OFFICE OF BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 NORTH FRANKLIN STREET
BASTROP LA
71220
US

IV. Provider business mailing address

218 N FRANKLIN ST
BASTROP LA
71220-3818
US

V. Phone/Fax

Practice location:
  • Phone: 318-283-0817
  • Fax:
Mailing address:
  • Phone: 318-283-0817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number101
License Number StateLA

VIII. Authorized Official

Name: MS. BRENDA KAYE RICKS
Title or Position: RN3
Credential: REGISTERED NURSE
Phone: 318-283-0817