Healthcare Provider Details

I. General information

NPI: 1386018059
Provider Name (Legal Business Name): NEAL CITIZEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BERTRAND DR
LAFAYETTE LA
70506-5632
US

IV. Provider business mailing address

540 E MAPLE AVE
EUNICE LA
70535-5651
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-8781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: