| NPI | 1568653087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY R DEAVILLE Director Of Clinical Operations 337-237-0788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 839) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: LA 880) |
| 103T00000X Psychologist (Licence: MS 40-005) | |
| 103T00000X Psychologist (Licence: LA 846) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2008-06-16 |