Provider Demographics
NPI:1962278762
Name:HOLISTIC BEHAVIORAL HEALTH SERVICES OF LOUISIANA
Entity type:Organization
Organization Name:HOLISTIC BEHAVIORAL HEALTH SERVICES OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMIE
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-371-2945
Mailing Address - Street 1:1640 S COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-5800
Mailing Address - Country:US
Mailing Address - Phone:985-241-5284
Mailing Address - Fax:985-317-1825
Practice Address - Street 1:1640 S COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-5800
Practice Address - Country:US
Practice Address - Phone:985-241-5284
Practice Address - Fax:985-317-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility