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General NPI Number Information
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NPI Number | 1114550001
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Entity Type | Organization
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Legal Business Name | BEACON BEHAVIORAL HOSPITAL LLC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 12/24/2020
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Provider Practice Location Address
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Address Line | 42382 DELUXE PLZ STE 34
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City | HAMMOND
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State | LA
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Zip | 70403-1236
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Country | US
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Telephone | 985-956-7378
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Fax | 985-956-7381
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Provider Business Mailing Address
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Address Line | 4601 BLUEBONNET BLVD STE B
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City | BATON ROUGE
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State | LA
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Zip | 70809-9656
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Country | US
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Telephone | 225-810-4040
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Fax | 225-810-4050
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Authorized Official
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Title or Position | CEO
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Name | MR. PHILLIP SEAN WENDELL
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Credential |
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Telephone | 225-810-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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