MEDICARE: ACADIANA PSYCHIATRIC SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	2084P0800X	Psychiatry Physician
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275926230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADIANA PSYCHIATRIC SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	PO BOX 53709
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-3709
Country	:	US
Telephone Number	:	337-205-6445
Fax Number	:	337-735-9898

Provider Business Practice Location Address
First Line	:	217 BREVARD CT STE C
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-3997
Country	:	US
Telephone Number	:	318-545-2451
Fax Number	:	866-990-8296

Authorized Official
Title or Position	:	OWNER/CEO/NURSE PRACTITIONER
Name	:	MR. MARK DECLOUET
Credential	:	NP
Telephone Number	:	337-322-2471

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	01/27/2022

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