Healthcare Provider Details

I. General information

NPI: 1477419422
Provider Name (Legal Business Name): HORTENCIA CERVANTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 DULLES DR
LAFAYETTE LA
70506-3008
US

IV. Provider business mailing address

100 RAGIN LOFTS ALY
LAFAYETTE LA
70506-4300
US

V. Phone/Fax

Practice location:
  • Phone: 337-262-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11411
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: