Healthcare Provider Details

I. General information

NPI: 1114698776
Provider Name (Legal Business Name): STEPHANIE DANIELLE FARRIS PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W PINHOOK RD STE 107
LAFAYETTE LA
70503-3100
US

IV. Provider business mailing address

204 MOSS BLUFF DR
LAFAYETTE LA
70507-2753
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-9457
  • Fax: 337-232-9459
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC10543
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: