NPIMap

Organization Active NPI

Northeast Delta Human Services Authority

Doing business as Monroe Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Monroe, LA
National Provider Identifier
1033551833
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
2203782610 Issued in LA
Legal business name
NORTHEAST DELTA HUMAN SERVICES AUTHORITY
Doing business as
Monroe Behavioral Health Clinic
Practice address
4800 S Grand St
Monroe, LA 71202-6412
Phone
(318) 362-3339
Fax
(318) 362-3336
NPI assigned
Jul 22, 2013
Last updated
Oct 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Octavia Green
Title
Administrative Program Specialist B
Phone
(318) 362-3270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 2203782610 LA Primary

Addresses

Primary practice location

4800 S Grand St
Monroe, LA 71202-6412

Mailing address

4800 S Grand St
Monroe, LA 71202-6412
Phone (318) 362-3339

Other identifiers 1

IdentifierTypeStateIssuer
1710237MedicaidLA

Other names 1

  • Monroe Behavioral Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150121001268 LA Part B Supplier - Clinic/Group Practice 2961726005 Receives reassigned benefits from 29 practitioners
15 other NPIs on this enrollment
Practice locations: Tallulah, LA; Winnsboro, LA; Ruston, LA; Monroe, LA; Columbia, LA; Bastrop, LA

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Northeast Delta Human Services Authority14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1033551833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 S GRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026412",
            "telephone_number": "318-362-3339",
            "fax_number": "318-362-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 S GRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026412",
            "telephone_number": "318-362-3339",
            "fax_number": "318-362-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DELTA HUMAN SERVICES AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-22",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "OCTAVIA",
        "authorized_official_title_or_position": "ADMINISTRATIVE PROGRAM SPECIALIST B",
        "authorized_official_telephone_number": "318-362-3270"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "LA",
            "license": "2203782610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710237",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monroe Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.