MEDICARE: RISE BEHAVIORAL SERVICES 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1942773015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE BEHAVIORAL SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 1806
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-1806
Country	:	US
Telephone Number	:	225-305-4542
Fax Number	:	844-270-3049

Provider Business Practice Location Address
First Line	:	9305 MAIN ST STE E
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-7441
Country	:	US
Telephone Number	:	225-278-1020
Fax Number	:	844-270-3049

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DONYELLE KENNEDY
Credential	:	BCBA
Telephone Number	:	225-305-4542

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	04/25/2022

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