Healthcare Provider Details

I. General information

NPI: 1770911109
Provider Name (Legal Business Name): LEI BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 S I 10 SERVICE RD W STE 215
METAIRIE LA
70001-7436
US

IV. Provider business mailing address

4300 S I 10 SERVICE RD W STE 215
METAIRIE LA
70001-7436
US

V. Phone/Fax

Practice location:
  • Phone: 504-301-9990
  • Fax: 504-265-9370
Mailing address:
  • Phone: 504-301-9990
  • Fax: 504-265-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateLA

VIII. Authorized Official

Name: LUCKY IHENYEN
Title or Position: OWNER
Credential:
Phone: 919-491-5382