Physicians Behavioral Hospital, LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

PHYSICIANS BEHAVIORAL HOSPITAL, LLC

Doing business as

Physicians Behavioral Hospital

Practice address

2025 Desoto St
Shreveport, LA 71103-4717

Phone

(318) 550-0520

NPI assigned

May 25, 2007

Last updated

Jul 8, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. William E. Logan III

Title

Manager

Phone

(337) 233-4165

Specialties & licenses 1

Addresses

Other names 1

• Physicians Behavioral Hospital Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356552806. Details of each certification follow.

• CCN 194094 Hospital · Active · Details

Hospital certification: CCN 194094

Legal name

PHYSICIANS BEHAVIORAL HOSPITAL, LLC

Doing business as

PHYSICIANS BEHAVIORAL HOSPITAL

Certification status

Active

Provider type (POS)

Hospital – Psychiatric

Participating since

Apr 17, 2008

Last certification

Oct 18, 2021

Beds

42

Ownership / control type

Private (for profit)

Organization structure

LLCProprietary

Enrollment address

2025 Desoto St
Shreveport, LA 71103-4717
Main/Primary Hospital Location

Hospital subgroups

Psychiatric

Listed as

Physicians Behavioral HospitalCCN 194094 · All quality measures

Type

Psychiatric

Ownership

Proprietary

Medicare certification status

ActiveFrom the Provider of Services file

Emergency services

No

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 5

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.

• Shannon K Fowler, LPC LICENSE NO 7745

  • Mental Health Counselor
  • Shreveport, LA
  • NPI 1194099259
  NPD (past)
• David Michael Murdock, M.D.

  • Psychiatry Physician
  • Lake Charles, LA
  • NPI 1508830316
  NPD (past)
• Vesela T Tzoneva-Kamberova, MD

  • Psychiatry Physician
  • Shreveport, LA
  • NPI 1356436794
  NPD (past)
• Robert Elec Ward, M.S.

  • Professional Counselor
  • Shreveport, LA
  • NPI 1558400085
  NPD (past)
• Blake Henchcliffe, MD

  • Psychiatry Physician
  • Amarillo, TX
  • NPI 1982191409
  NPD (past)

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1356552806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 JEFFERSON ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705016910",
            "telephone_number": "337-233-4165",
            "fax_number": "337-237-6729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 DESOTO ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034717",
            "telephone_number": "318-550-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS BEHAVIORAL HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "337-233-4165",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Behavioral Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lloyd Phillips, M.D.
• Trandi Lynette Phillips
• Veronica Phillips
• Joonho Phiyo
• Phoenix Health Services, LLC
• Patricia Pichilingue Reto, MD
• Polly Lynn Pickard
• Vicki Su Pickard, M.S., P.T.
• Jalynn Mar'Dai Pickens
• Jerry Pickens, M.A.

• Psychiatric Hospital in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Psychiatric Hospital in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.