Organization
PEGASUS BEHAVIORAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY DAVIS (CREDENTIALING SPECIALISTS)
(912) 373-4385
Entity
Organization
Contact information
Practice address
400 MARINERS PLAZA DR STE 409D, MANDEVILLE, LA 70448-6849
(985) 224-0412
(985) 202-9331
Mailing address
116 CARMEL DR, MANDEVILLE, LA 70448-4127
(985) 224-0412
(985) 202-9331
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6961
STATE LICENSE
LA
Enumeration date
10/28/2020
Last updated
07/30/2025
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