Organization
BEACON BEHAVIORAL HOSPITAL NORTHSHORE, LLC
Active
Parent organization
BEACON BEHAVIORAL HOSPITAL NORTHSHORE, LLC
Other names
Beacon Behavioral Outpatient - Bogalusa
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEACON BEHAVIORAL HOSPITAL NORTHSHORE, LLC
Authorized official
MR. PHILLIP SEAN WENDELL (CEO)
(225) 810-4040
Entity
Organization
Contact information
Practice address
1640 S COLUMBIA ST STE B, BOGALUSA, LA 70427-5800
(985) 735-1750
(985) 735-1752
Mailing address
4601 BLUEBONNET BLVD STE B, BATON ROUGE, LA 70809-9656
(225) 810-4040
(225) 810-4050
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08036043
—
MS
05
—
1709549
—
LA
01
—
194080
MEDICARE
—
Enumeration date
02/19/2020
Last updated
04/12/2021
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