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General NPI Number Information
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NPI Number | 1225285554
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Entity Type | Organization
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Legal Business Name | RENEWING BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 119 N 13TH ST
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City | OAKDALE
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State | LA
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Zip | 71463-2742
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Country | US
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Telephone | 318-306-2482
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Fax | 313-335-2907
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Provider Business Mailing Address
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Address Line | 409 N 11TH ST
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City | OAKDALE
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State | LA
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Zip | 71463-2652
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KERRY DEWAYNE LEDET
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Credential |
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Telephone | 318-306-2482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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