Healthcare Provider Details

I. General information

NPI: 1801257795
Provider Name (Legal Business Name): INDEPENDENT BEHAVIORAL MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2016
Last Update Date: 03/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 S RIDGE DR
MANDEVILLE LA
70448-1022
US

IV. Provider business mailing address

1385 S RIDGE DR
MANDEVILLE LA
70448-1022
US

V. Phone/Fax

Practice location:
  • Phone: 888-214-4264
  • Fax:
Mailing address:
  • Phone: 888-214-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TATIANA SOFIA BEGAULT
Title or Position: PROGRAM COORDINATOR
Credential: B.S.
Phone: 504-275-7489