Healthcare Provider Details

I. General information

NPI: 1891719944
Provider Name (Legal Business Name): PERCIVAL CHIQUITA DYER LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 SPRINGFIELD RD
BATON ROUGE LA
70807
US

IV. Provider business mailing address

PO BOX 308
BAKER LA
70704-0308
US

V. Phone/Fax

Practice location:
  • Phone: 866-311-7565
  • Fax: 866-311-7565
Mailing address:
  • Phone: 866-311-7565
  • Fax: 866-311-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2120
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14015
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number975
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: