Healthcare Provider Details

I. General information

NPI: 1013540061
Provider Name (Legal Business Name): HEATON-MCCOY PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 DEMANADE BLVD
LAFAYETTE LA
70503-2508
US

IV. Provider business mailing address

132 DEMANADE BLVD
LAFAYETTE LA
70503-2508
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-8679
  • Fax:
Mailing address:
  • Phone: 337-534-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KRISTOFFER G MCCOY
Title or Position: MANAGER
Credential: MD
Phone: 337-962-1735