Department of Health and Hospitals

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

100 Issued in LA

Legal business name

DEPARTMENT OF HEALTH AND HOSPITALS

Doing business as

Jonesboro Behavioral Health Clinic

Practice address

602 E Georgia Ave
Ruston, LA 71270-3931

Phone

(318) 251-4125

Fax

(318) 251-5000

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Mark Debord, LCSW

Title

Regional Administrat

Phone

(318) 362-3270

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jonesboro Behavioral Health Clinic Doing business as

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374537600000",
    "number": "1215074430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 FERRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013210",
            "telephone_number": "318-362-3270",
            "fax_number": "318-362-3268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 E GEORGIA AVE",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712703931",
            "telephone_number": "318-251-4125",
            "fax_number": "318-251-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF HEALTH AND HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2013-07-23",
        "status": "A",
        "authorized_official_last_name": "DEBORD",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "REGIONAL ADMINISTRAT",
        "authorized_official_telephone_number": "318-362-3270",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "LA",
            "license": "100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710571",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jonesboro Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Ruston, LA
• Providers in Ruston, LA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.