Healthcare Provider Details

I. General information

NPI: 1427988567
Provider Name (Legal Business Name): PETER ERNEST PERSSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19344 N 10TH ST
COVINGTON LA
70433-8877
US

IV. Provider business mailing address

57 WALNUT PL
COVINGTON LA
70433-5733
US

V. Phone/Fax

Practice location:
  • Phone: 985-966-2312
  • Fax:
Mailing address:
  • Phone: 985-966-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC11140
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: