Healthcare Provider Details

I. General information

NPI: 1265573877
Provider Name (Legal Business Name): LARRY J. BENOIT, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CAILLOUETT PL
LAFAYETTE LA
70501-7807
US

IV. Provider business mailing address

119 CAILLOUETT PL
LAFAYETTE LA
70501-7807
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-4912
  • Fax: 337-234-6064
Mailing address:
  • Phone: 337-234-4912
  • Fax: 337-234-6064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number541
License Number StateLA

VIII. Authorized Official

Name: DR. LARRY J BENOIT
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 337-234-4912