MEDICARE: DR. STACI GUIDRY LENOX PH.D

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	103TC0700X	Clinical Psychologist	746	LA

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	:	1659495521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACI GUIDRY LENOX PH.D

Provider Business Mailing Address
First Line	:	4212 W. CONGRESS ST.
Second Line	:	SUITE 3500
City	:	LAFAYETTE
State	:	LA
Zip	:	70506
Country	:	US
Telephone Number	:	337-235-8304
Fax Number	:	337-235-5924

Provider Business Practice Location Address
First Line	:	4212 W. CONGRESS ST.
Second Line	:	SUITE 3500
City	:	LAFAYETTE
State	:	LA
Zip	:	70506
Country	:	US
Telephone Number	:	337-235-8304
Fax Number	:	337-235-5924

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

Provider Enumeration Date	:	03/18/2007
Last Update Date	:	03/28/2019

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