Healthcare Provider Details

I. General information

NPI: 1831389741
Provider Name (Legal Business Name): PSYCHIATRIC ASSOCIATES OF SOUTHWEST LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 RUE FOUNTAINE
LAFAYETTE LA
70508-5744
US

IV. Provider business mailing address

119 RUE FOUNTAINE
LAFAYETTE LA
70508-5744
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9163
  • Fax: 337-991-9165
Mailing address:
  • Phone: 337-991-9163
  • Fax: 337-991-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP04893
License Number StateLA

VIII. Authorized Official

Name: DR. CHARLES E BRAMLET JR.
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 337-991-9163