MEDICARE: MR. DAVID PAUL WYMAN LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	588	LA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1487890448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID PAUL WYMAN LAC

Provider Business Mailing Address
First Line	:	211 WOODLAND CIR
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2912
Country	:	US
Telephone Number	:	337-322-6899
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ASMA BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3858
Country	:	US
Telephone Number	:	337-456-7880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	12/04/2018

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