Organization
IMPACT BEHAVIOR HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ANTHONY CLARK (CEO)
(225) 771-8849
Entity
Organization
Contact information
Practice address
12147 COURSEY BLVD, BATON ROUGE, LA 70816-4410
(225) 771-8849
(225) 771-8876
Mailing address
12147 COURSEY BLVD, BATON ROUGE, LA 70816-4410
(225) 771-8849
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6260
LA
Other
Enumeration date
11/09/2015
Last updated
11/09/2015
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