Healthcare Provider Details

I. General information

NPI: 1164423570
Provider Name (Legal Business Name): LAKE AREA PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DR MICHAEL DEBAKEY DR STE 301
LAKE CHARLES LA
70601-5864
US

IV. Provider business mailing address

401 DR MICHAEL DEBAKEY DR STE 301
LAKE CHARLES LA
70601-5864
US

V. Phone/Fax

Practice location:
  • Phone: 337-478-9331
  • Fax: 337-478-9828
Mailing address:
  • Phone: 337-478-9331
  • Fax: 337-478-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BETHANNE CARSON
Title or Position: OWNER/CEO
Credential: APRN, PMHNP-BC
Phone: 337-478-9331