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NPI Code Detail

MEDICARE: MRS. IVY DESIRAE BENNETT SIAS M.S., NCC, LPC

MEDICARE: MRS. IVY DESIRAE BENNETT SIAS M.S., NCC, LPC
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
1101Y00000XCounselor5550LA
2101YP2500XProfessional Counselor5550LA

General Provider Information

NPI Number : 1659741999
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. IVY DESIRAE BENNETT SIAS M.S., NCC, LPC
Provider Business Mailing Address
First Line : 326 SAINT MATTHIAS DR
Second Line :
City : CARENCRO
State : LA
Zip : 70520-5576
Country : US
Telephone Number : 310-429-5025
Fax Number :
Provider Business Practice Location Address
First Line : 1010 AUBURN AVE
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-2308
Country : US
Telephone Number : 337-232-9457
Fax Number : 337-232-9459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2015
Last Update Date : 09/29/2015

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