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NPI Code Detail

MEDICARE: BEHAVIORAL SERVICES OF LOUISIANA, L.L.C.

MEDICARE: BEHAVIORAL SERVICES OF LOUISIANA, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1215365689
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEHAVIORAL SERVICES OF LOUISIANA, L.L.C.
Provider Business Mailing Address
First Line : 1000 CHINABERRY DR STE 900
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-2455
Country : US
Telephone Number : 318-746-0420
Fax Number : 318-626-5429
Provider Business Practice Location Address
First Line : 8326 KELWOOD AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-4803
Country : US
Telephone Number : 225-929-5738
Fax Number : 225-929-9740
Authorized Official
Title or Position : OWNER/AGENT OF SERVICE
Name : ALEXANDER BLONDEAU
Credential : J.D.
Telephone Number : 225-293-2700
Provider Enumeration Date : 10/23/2013
Last Update Date : 07/24/2023

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1457722860 — DOMINIQUE HAUGHTON
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70806-4803
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