Divine Impact Behavioral Support Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

41056835 Issued in LA

Legal business name

DIVINE IMPACT BEHAVIORAL SUPPORT SERVICES LLC

Practice address

1799 Stumpf Blvd
Building 5 Suite 1
Terrytown, LA 70056-3950

Phone

(504) 330-0788

NPI assigned

Feb 18, 2016

Last updated

Feb 18, 2016By 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

Miss Patrice Noel Pasley

Title

Owner

Phone

(504) 330-0788

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455753600000",
    "number": "1457710493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1799 STUMPF BLVD",
            "address_2": "BUILDING 5 SUITE 1",
            "city": "TERRYTOWN",
            "state": "LA",
            "postal_code": "700563950",
            "telephone_number": "504-330-0788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1799 STUMPF BLVD",
            "address_2": "BUILDING 5 SUITE 1",
            "city": "TERRYTOWN",
            "state": "LA",
            "postal_code": "700563950",
            "telephone_number": "504-330-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE IMPACT BEHAVIORAL SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-18",
        "last_updated": "2016-02-18",
        "status": "A",
        "authorized_official_last_name": "PASLEY",
        "authorized_official_first_name": "PATRICE",
        "authorized_official_middle_name": "NOEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-330-0788",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "LA",
            "license": "41056835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Terrytown, LA
• Providers in Terrytown, LA by specialty
• Community/Behavioral Health Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; 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.