Healthcare Provider Details

I. General information

NPI: 1790537579
Provider Name (Legal Business Name): SERENITY PSYCHIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 JOHNSTON ST STE K PMB 1205
LAFAYETTE LA
70503
US

IV. Provider business mailing address

10904 HARGROVE RD
ABBEVILLE LA
70510-6328
US

V. Phone/Fax

Practice location:
  • Phone: 337-523-6482
  • Fax:
Mailing address:
  • Phone: 337-523-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. ISABELLE M DUBOIS
Title or Position: SOLE MEMBER / PROVIDER
Credential: PMHNP
Phone: 337-523-6482