Healthcare Provider Details

I. General information

NPI: 1053710350
Provider Name (Legal Business Name): JULIE DEKEYZER MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 04/02/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 MACARTHUR DR BUILDING 6
ALEXANDRIA LA
71301-3720
US

IV. Provider business mailing address

440 BELGARD BEND ROAD
BOYCE LA
71409-9638
US

V. Phone/Fax

Practice location:
  • Phone: 318-201-8385
  • Fax:
Mailing address:
  • Phone: 318-201-8385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number11247
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: