| Beacon Behavioral Outpatient - Bogalusa | |
|
1640 S Columbia St Ste B Bogalusa LA 70427-5800 | |
| (985) 735-1750 | |
| (985) 735-1752 |
| Full Name | Beacon Behavioral Outpatient - Bogalusa |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1640 S Columbia St Ste B, Bogalusa, Louisiana |
| Authorized Official Name and Position | Phillip Sean Wendell (CEO) |
| Authorized Official Contact | 2258104040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Behavioral Outpatient - Bogalusa 4601 Bluebonnet Blvd Ste B Baton Rouge LA 70809-9656 Ph: (225) 810-4040 | Beacon Behavioral Outpatient - Bogalusa 1640 S Columbia St Ste B Bogalusa LA 70427-5800 Ph: (985) 735-1750 |
| NPI Number | 1558994434 |
|---|---|
| Provider Enumeration Date | 02/19/2020 |
| Last Update Date | 04/12/2021 |
| Certification Date | 04/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558994434 | NPI | - | NPPES |
| 08036043 | Medicaid | MS | |
| 194080 | Other | MEDICARE | |
| 1709549 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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