Healthcare Provider Details

I. General information

NPI: 1043099773
Provider Name (Legal Business Name): SCOTT DAVID MECHE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 KALISTE SALOOM RD
LAFAYETTE LA
70508-7449
US

IV. Provider business mailing address

114 SAN SEBASTIAN DR
YOUNGSVILLE LA
70592-6700
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-0788
  • Fax:
Mailing address:
  • Phone: 225-505-9664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1023
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: