NPIMap

Organization Active NPI

Northeast Delta Human Services Authority

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tallulah, LA
National Provider Identifier
1689016487
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
2203782765 Issued in LA
Legal business name
NORTHEAST DELTA HUMAN SERVICES AUTHORITY
Practice address
1012 Johnson St
Tallulah, LA 71282-5216
Phone
(318) 574-1713
Fax
(381) 574-2299
NPI assigned
Jul 22, 2013
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
Adminsitrative Program Specialist B
Phone
(318) 362-3270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 2203782765 LA Primary

Addresses

Primary practice location

1012 Johnson St
Tallulah, LA 71282-5216

Mailing address

1012 Johnson St
Tallulah, LA 71282-5216
Phone (318) 574-1713

Other identifiers 1

IdentifierTypeStateIssuer
1710351MedicaidLA

Other names 1

  • Tallulah 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
This NPI is an additional NPI on the 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 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1689016487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 JOHNSON ST",
            "city": "TALLULAH",
            "state": "LA",
            "postal_code": "712825216",
            "telephone_number": "318-574-1713",
            "fax_number": "381-574-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 JOHNSON ST",
            "city": "TALLULAH",
            "state": "LA",
            "postal_code": "712825216",
            "telephone_number": "318-574-1713",
            "fax_number": "381-574-2299"
        }
    ],
    "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": "ADMINSITRATIVE 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": "2203782765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710351",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tallulah Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallulah, 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.