Healthcare Provider Details

I. General information

NPI: 1558413013
Provider Name (Legal Business Name): HENRY JAY LAGARDE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 FRENCH STREET
NEW IBERIA LA
70560
US

IV. Provider business mailing address

217 FRENCH STREET
NEW IBERIA LA
70560
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-6604
  • Fax: 337-367-6963
Mailing address:
  • Phone: 337-367-6604
  • Fax: 337-367-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLA353
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: