MEDICARE: BEACON BEHAVIORAL HEALTH-SLIDELL, INC.

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	:	1629275573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON BEHAVIORAL HEALTH-SLIDELL, INC.

Provider Business Mailing Address
First Line	:	9938 AIRLINE HWY
Second Line	:	SUITE 200
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8100
Country	:	US
Telephone Number	:	225-810-4040
Fax Number	:	225-810-4050

Provider Business Practice Location Address
First Line	:	113 CHRISTIAN LN
Second Line	:	SUITE A
City	:	SLIDELL
State	:	LA
Zip	:	70458-1350
Country	:	US
Telephone Number	:	985-607-0290
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SEAN WENDELL
Credential	:	CPA
Telephone Number	:	225-810-4040

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	12/30/2009

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