Healthcare Provider Details

I. General information

NPI: 1376099762
Provider Name (Legal Business Name): ENRICH BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BETIN AVE
MONROE LA
71201-5143
US

IV. Provider business mailing address

114 BETIN AVE
MONROE LA
71201-5143
US

V. Phone/Fax

Practice location:
  • Phone: 318-614-4728
  • Fax:
Mailing address:
  • Phone: 318-570-2981
  • Fax: 318-322-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRENDA HAYES-WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-614-4728