Healthcare Provider Details

I. General information

NPI: 1689334963
Provider Name (Legal Business Name): BKC MENTAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ROBLEY DRIVE
LAFAYETTE LA
70503
US

IV. Provider business mailing address

4400 AMBASSADOR CAFFERY PKWY STE A #267
LAFAYETTE LA
70508-6706
US

V. Phone/Fax

Practice location:
  • Phone: 318-805-2705
  • Fax:
Mailing address:
  • Phone: 318-805-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRITTANYE CAIN
Title or Position: OWNER
Credential: LPC, LMFT
Phone: 318-805-2705