MEDICARE: LISA J MANUEL PSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1619830866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA J MANUEL PSS

Provider Business Mailing Address
First Line	:	1113 PLUM ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-8337
Country	:	US
Telephone Number	:	225-246-2162
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 COLONIAL DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6549
Country	:	US
Telephone Number	:	225-246-2162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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