Healthcare Provider Details

I. General information

NPI: 1437901220
Provider Name (Legal Business Name): LAKEFRONT BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 GIROD ST
MANDEVILLE LA
70448-5206
US

IV. Provider business mailing address

620 GIROD ST
MANDEVILLE LA
70448-5206
US

V. Phone/Fax

Practice location:
  • Phone: 985-200-1223
  • Fax: 985-246-3198
Mailing address:
  • Phone: 985-200-1223
  • Fax: 985-246-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: JODI L LADNER
Title or Position: OWNER
Credential: MS, NCC
Phone: 985-200-1223