MEDICARE: LOUISIANA BEHAVIORAL SPECIALISTS, LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1407241649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA BEHAVIORAL SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	6008 CAMERON BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9970 LAKE FOREST BLVD
Second Line	:	SUITE A
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2609
Country	:	US
Telephone Number	:	504-208-8600
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RENATA WEATHERSPOON
Credential	:	PMHNP-BC
Telephone Number	:	504-208-8600

Provider Enumeration Date	:	04/04/2015
Last Update Date	:	05/01/2015

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