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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