Healthcare Provider Details

I. General information

NPI: 1740871565
Provider Name (Legal Business Name): LYNETTE HESLET PHD MP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GAUSE BLVD STE 304
SLIDELL LA
70458-2854
US

IV. Provider business mailing address

PO BOX 85
KAPLAN LA
70548-0085
US

V. Phone/Fax

Practice location:
  • Phone: 985-445-1444
  • Fax: 985-445-1285
Mailing address:
  • Phone: 337-643-8424
  • Fax: 337-643-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LYNETTE HESLET
Title or Position: OWNER
Credential: PHD MP
Phone: 985-445-1444