Healthcare Provider Details

I. General information

NPI: 1366346397
Provider Name (Legal Business Name): DEVERAL A LAFOUNTAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 PATTY ST
OPELOUSAS LA
70570-2481
US

IV. Provider business mailing address

671 PATTY ST
OPELOUSAS LA
70570-2481
US

V. Phone/Fax

Practice location:
  • Phone: 337-290-4424
  • Fax:
Mailing address:
  • Phone: 337-290-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC11210
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC11210
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: