Healthcare Provider Details

I. General information

NPI: 1699083261
Provider Name (Legal Business Name): MICHAEL BERARD, PH.D., M.P., A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W SAINT MARY BLVD SUITE 406
LAFAYETTE LA
70506-3568
US

IV. Provider business mailing address

PO BOX 52612
LAFAYETTE LA
70505-2612
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-7867
  • Fax: 337-235-7199
Mailing address:
  • Phone: 337-233-7867
  • Fax: 337-235-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberMPAP.000010
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberMPAP.000010
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMPAP.000010
License Number StateLA

VIII. Authorized Official

Name: DR. MICHAEL BERARD
Title or Position: MEDICAL PSYCHOLOGIST
Credential: PH.D., MPAP
Phone: 337-233-7867