Healthcare Provider Details

I. General information

NPI: 1770051005
Provider Name (Legal Business Name): KERRI PREJEAN ED.D., LPC-S, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 GRAND POINT RD
BREAUX BRIDGE LA
70517-3323
US

IV. Provider business mailing address

2309 GRAND POINT RD
BREAUX BRIDGE LA
70517-3323
US

V. Phone/Fax

Practice location:
  • Phone: 337-935-2310
  • Fax: 337-395-3940
Mailing address:
  • Phone: 337-935-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4460
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: