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General NPI Number Information
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NPI Number | 1093208548
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH CLINIC LLC
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Dates
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Enumeration Date | 06/10/2018
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Last Update Date | 06/10/2018
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Provider Practice Location Address
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Address Line | 2500 MAPLEWOOD DR STE 1
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City | SULPHUR
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State | LA
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Zip | 70663-6100
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Country | US
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Telephone | 337-625-5766
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Fax | 225-208-1056
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Provider Business Mailing Address
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Address Line | 2500 MAPLEWOOD DR STE 1
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City | SULPHUR
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State | LA
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Zip | 70663-6100
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Country | US
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Telephone | 337-625-5766
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Fax | 225-208-1056
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ANDREW JUSTIN THRASHER III
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Credential | PHD
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Telephone | 337-625-5766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP05308
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1412
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License Number State | LA
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