Healthcare Provider Details

I. General information

NPI: 1437668761
Provider Name (Legal Business Name): CONTRELLA E. CONWAY MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W VERMILION ST
LAFAYETTE LA
70501-6729
US

IV. Provider business mailing address

7717 HOPELAND PLANTATION DR
NEW IBERIA LA
70560-9663
US

V. Phone/Fax

Practice location:
  • Phone: 337-345-6133
  • Fax:
Mailing address:
  • Phone: 337-255-6769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: