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217 Brevard Ct Ste C Alexandria LA 71303-3997 | |
| (318) 545-2451 | |
| (866) 990-8296 |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 217 Brevard Ct Ste C, Alexandria, Louisiana |
| Authorized Official Name and Position | Mark Declouet (OWNER/CEO/NURSE PRACTITIONER) |
| Authorized Official Contact | 3373222471 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 53709 Lafayette LA 70505-3709 Ph: (337) 205-6445 | 217 Brevard Ct Ste C Alexandria LA 71303-3997 Ph: (318) 545-2451 |
| NPI Number | 1275926230 |
|---|---|
| Provider Enumeration Date | 03/13/2015 |
| Last Update Date | 01/27/2022 |
| Certification Date | 01/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275926230 | NPI | - | NPPES |
| 2543491 | Medicaid | LA |
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