Healthcare Provider Details

I. General information

NPI: 1265352439
Provider Name (Legal Business Name): BEACON BEHAVIORAL OUTPATIENT JACKSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5898 RIDGEWOOD RD STE A
JACKSON MS
39211-2661
US

IV. Provider business mailing address

14707 PERKINS RD
BATON ROUGE LA
70810-2216
US

V. Phone/Fax

Practice location:
  • Phone: 225-810-4040
  • Fax: 225-810-4050
Mailing address:
  • Phone: 225-810-4040
  • Fax: 225-810-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS THOMASON
Title or Position: VP OF RCM
Credential:
Phone: 504-910-6056