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General NPI Number Information
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NPI Number | 1548808058
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Entity Type | Individual
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Provider Name | DEANDRE S. JOHN
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Gender | Male
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1405 W PINHOOK RD STE 107
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City | LAFAYETTE
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State | LA
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Zip | 70503-3100
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Country | US
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Telephone | 337-232-9457
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Fax | 337-232-9459
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Provider Business Mailing Address
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Address Line | 505 10TH ST
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-3905
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Country | US
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Telephone | 310-270-7749
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PLC10562
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License Number State | LA
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