Healthcare Provider Details

I. General information

NPI: 1134418502
Provider Name (Legal Business Name): PSYCHOLOGICAL HEALTH CARE OF SOUTH LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 HOUMA ST
HOUMA LA
70360-4420
US

IV. Provider business mailing address

1016 HOUMA ST
HOUMA LA
70360-4420
US

V. Phone/Fax

Practice location:
  • Phone: 985-859-5455
  • Fax: 985-859-5455
Mailing address:
  • Phone: 985-859-5455
  • Fax: 985-859-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number895
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.0014
License Number StateLA

VIII. Authorized Official

Name: DR. KENNETH CHRISTOPHER RACHAL
Title or Position: PRESIDENT
Credential: PHD, MP
Phone: 985-859-5455