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General NPI Number Information
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NPI Number | 1265352439
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Entity Type | Organization
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Legal Business Name | BEACON BEHAVIORAL OUTPATIENT JACKSON LLC
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Dates
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Enumeration Date | 07/17/2026
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Last Update Date | 07/17/2026
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Provider Practice Location Address
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Address Line | 5898 RIDGEWOOD RD STE A
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City | JACKSON
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State | MS
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Zip | 39211-2661
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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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Provider Business Mailing Address
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Address Line | 14707 PERKINS RD
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City | BATON ROUGE
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State | LA
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Zip | 70810-2216
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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 | VP OF RCM
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Name | ALEXIS THOMASON
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Credential |
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Telephone | 504-910-6056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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