Healthcare Provider Details

I. General information

NPI: 1508043167
Provider Name (Legal Business Name): BEHAVIORAL INTERVENTION GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 BLUEBONNET BLVD
BATON ROUGE LA
70810-1611
US

IV. Provider business mailing address

PO BOX 84376
BATON ROUGE LA
70884-4376
US

V. Phone/Fax

Practice location:
  • Phone: 225-757-8002
  • Fax:
Mailing address:
  • Phone: 225-757-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CASSIE BRADFORD
Title or Position: OWNER
Credential:
Phone: 225-921-2857