Provider Demographics
NPI:1023454451
Name:BEHAVIORAL DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:BEHAVIORAL DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOUDLOCHE
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCBA
Authorized Official - Phone:318-600-6640
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294
Mailing Address - Country:US
Mailing Address - Phone:318-600-6640
Mailing Address - Fax:866-405-4542
Practice Address - Street 1:3201 ARMAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3915
Practice Address - Country:US
Practice Address - Phone:318-600-6640
Practice Address - Fax:318-605-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4601101YM0800X
LAL-005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2349376Medicaid