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General NPI Number Information
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NPI Number | 1164423570
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Entity Type | Organization
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Legal Business Name | LAKE AREA PSYCHIATRY LLC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 401 DR MICHAEL DEBAKEY DR STE 301
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5864
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Country | US
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Telephone | 337-478-9331
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Fax | 337-478-9828
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Provider Business Mailing Address
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Address Line | 401 DR MICHAEL DEBAKEY DR STE 301
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5864
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Country | US
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Telephone | 337-478-9331
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Fax | 337-478-9828
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Authorized Official
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Title or Position | OWNER/CEO
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Name | BETHANNE CARSON
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Credential | APRN, PMHNP-BC
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Telephone | 337-478-9331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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