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Organization
NORTHEAST DELTA HUMAN SERVICES AUTHORITY
Active
Organization
NORTHEAST DELTA HUMAN SERVICES AUTHORITY
Active
Other names
Ruston Behavioral Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
OCTAVIA GREEN (ADMINISTRATIVE PROGRAM SPECIALIST B)
(318) 362-3270
Entity
Organization
Contact information
Practice address
901 WHITE ST, RUSTON, LA 71270-5960
(318) 251-4125
(318) 251-5000
Mailing address
901 WHITE ST, RUSTON, LA 71270-5960
(318) 251-4125
(318) 251-5000
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710342
—
LA
01
—
2203785977
STATE LICENSE
LA
Enumeration date
07/30/2013
Last updated
03/20/2024
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