Healthcare Provider Details

I. General information

NPI: 1437516739
Provider Name (Legal Business Name): LAUREN DUPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 CLECO ST
MANSURA LA
71350-4451
US

IV. Provider business mailing address

PO BOX 450
MANSURA LA
71350-0450
US

V. Phone/Fax

Practice location:
  • Phone: 318-964-2679
  • Fax: 318-964-2683
Mailing address:
  • Phone: 318-964-2679
  • Fax: 318-964-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: