Healthcare Provider Details

I. General information

NPI: 1902017114
Provider Name (Legal Business Name): DORIS EILEEN NEVIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 11/15/2022
Certification Date: 11/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W PINHOOK RD STE 303
LAFAYETTE LA
70508-3735
US

IV. Provider business mailing address

305 LIVE OAK DR
LAFAYETTE LA
70503-3903
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-4214
  • Fax: 337-484-1405
Mailing address:
  • Phone: 540-354-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1431
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0810000245
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0810000245
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY-RXP0058
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number321261
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: