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General NPI Number Information
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NPI Number | 1891947479
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Entity Type | Organization
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Legal Business Name | JENNINGS BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 110 E DARBONNE ST
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City | SULPHUR
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State | LA
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Zip | 70663-4958
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Country | US
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Telephone | 337-527-7878
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Fax | 337-527-7880
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Provider Business Mailing Address
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Address Line | 110 E DARBONNE ST
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City | SULPHUR
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State | LA
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Zip | 70663-4958
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Country | US
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Telephone | 337-527-7878
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Fax | 337-527-7880
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Authorized Official
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Title or Position | MGR SULPHUR OUTPATIENT CLINIC
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Name | MRS. STACY GAUDET
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Credential |
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Telephone | 337-527-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1055
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8971
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 021615
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 014484R
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License Number State | LA
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP 05359
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License Number State | LA
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