Provider Demographics
NPI:1861126310
Name:VICTORY BEHAVIORAL CENTER LLC
Entity type:Organization
Organization Name:VICTORY BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-778-7553
Mailing Address - Street 1:296 BEAUVOIR RD STE 100-1311
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4051
Mailing Address - Country:US
Mailing Address - Phone:985-778-7553
Mailing Address - Fax:
Practice Address - Street 1:296 BEAUVOIR RD STE 100-1311
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4051
Practice Address - Country:US
Practice Address - Phone:985-778-7553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health