Healthcare Provider Details

I. General information

NPI: 1487141503
Provider Name (Legal Business Name): ASHLEY HEFNER CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CONGRESS ST STE D
LAFAYETTE LA
70501-5749
US

IV. Provider business mailing address

800 W CONGRESS ST STE D
LAFAYETTE LA
70501-5749
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-5994
  • Fax: 337-504-5994
Mailing address:
  • Phone: 337-504-5994
  • Fax: 337-504-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4081
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: