Healthcare Provider Details

I. General information

NPI: 1942070792
Provider Name (Legal Business Name): LAFAYETTE INTENSIVE OUTPATIENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E VEROT SCHOOL RD
LAFAYETTE LA
70508-3311
US

IV. Provider business mailing address

PO BOX 81098
LAFAYETTE LA
70598-1098
US

V. Phone/Fax

Practice location:
  • Phone: 337-857-5937
  • Fax:
Mailing address:
  • Phone: 337-857-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAY LAMBRIGHT
Title or Position: MANAGING MEMBER
Credential:
Phone: 337-857-5937