Provider Demographics
NPI:1538527858
Name:TWIN CITY BEHAVIORAL DEVELOPMENT SERVICES
Entity type:Organization
Organization Name:TWIN CITY BEHAVIORAL DEVELOPMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:318-512-5808
Mailing Address - Street 1:2107 HONOR ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3648
Mailing Address - Country:US
Mailing Address - Phone:318-340-1775
Mailing Address - Fax:318-340-0501
Practice Address - Street 1:1706 PARKVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202
Practice Address - Country:US
Practice Address - Phone:318-512-5808
Practice Address - Fax:318-340-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health