Healthcare Provider Details

I. General information

NPI: 1821909540
Provider Name (Legal Business Name): ALEXANDER CLAYTON MANUEL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KALISTE SALOOM RD STE 212
LAFAYETTE LA
70508-4230
US

IV. Provider business mailing address

104A RAGIN LOFTS ALY
LAFAYETTE LA
70506
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-4974
  • Fax:
Mailing address:
  • Phone: 337-321-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9455
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: