Healthcare Provider Details

I. General information

NPI: 1609248376
Provider Name (Legal Business Name): DECLOUET PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BILLEAUD LN
LAFAYETTE LA
70506-3108
US

IV. Provider business mailing address

100 BILLEAUD LN
LAFAYETTE LA
70506-3108
US

V. Phone/Fax

Practice location:
  • Phone: 337-280-0441
  • Fax:
Mailing address:
  • Phone: 337-280-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP08470
License Number StateLA

VIII. Authorized Official

Name: MR. MATTHEW ALEXANDER DECLOUET
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 337-280-0441