MEDICARE: LAFAYETTE PSYCHIATRIC SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0101238635	VA

General Provider Information

NPI Number	:	1427182815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAFAYETTE PSYCHIATRIC SERVICES

Provider Business Mailing Address
First Line	:	1443 N VEAUX LOOP
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1259
Country	:	US
Telephone Number	:	757-627-3898
Fax Number	:	757-627-0054

Provider Business Practice Location Address
First Line	:	1443 N VEAUX LOOP
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1259
Country	:	US
Telephone Number	:	757-627-3898
Fax Number	:	757-627-0054

Authorized Official
Title or Position	:	OWNER
Name	:	HUMA M HYDER
Credential	:	M.D.
Telephone Number	:	757-627-3898

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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