1538527858 NPI number — TWIN CITY BEHAVIORAL DEVELOPMENT SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538527858 NPI number — TWIN CITY BEHAVIORAL DEVELOPMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN CITY BEHAVIORAL DEVELOPMENT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538527858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2107 HONOR ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-3648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-340-1775
Provider Business Mailing Address Fax Number:
318-340-0501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1706 PARKVIEW DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-512-5808
Provider Business Practice Location Address Fax Number:
318-340-0501
Provider Enumeration Date:
02/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BURRELL
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
SPENCER
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-512-5808

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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