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General NPI Number Information
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NPI Number | 1962278762
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Entity Type | Organization
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Legal Business Name | HOLISTIC BEHAVIORAL HEALTH SERVICES OF LOUISIANA
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 1640 S COLUMBIA ST
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City | BOGALUSA
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State | LA
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Zip | 70427-5800
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Country | US
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Telephone | 985-241-5284
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Fax | 985-317-1825
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Provider Business Mailing Address
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Address Line | 1640 S COLUMBIA ST
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City | BOGALUSA
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State | LA
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Zip | 70427-5800
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Country | US
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Telephone | 985-241-5284
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Fax | 985-317-1825
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Authorized Official
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Title or Position | CEO
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Name | MR. TOMMIE JEROME DYER
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Credential |
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Telephone | 225-371-2945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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