| Azalea Health Services Texas Llc | |
|
725 Brentwood Blvd Lafayette LA 70503-4405 | |
| (337) 393-0678 | |
| (337) 279-2705 |
| Full Name | Azalea Health Services Texas Llc |
|---|---|
| Speciality | Social Worker |
| Location | 725 Brentwood Blvd, Lafayette, Louisiana |
| Authorized Official Name and Position | Kenneth Maggard (PRESIDENT) |
| Authorized Official Contact | 3373930678 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Azalea Health Services Texas Llc 725 Brentwood Blvd Lafayette LA 70503-4405 Ph: (337) 393-0678 | Azalea Health Services Texas Llc 725 Brentwood Blvd Lafayette LA 70503-4405 Ph: (337) 393-0678 |
| NPI Number | 1326871807 |
|---|---|
| Provider Enumeration Date | 08/21/2024 |
| Last Update Date | 08/21/2024 |
| Certification Date | 08/21/2024 |
| Medicare PECOS PAC ID | 6800327933 |
|---|---|
| Medicare Enrollment ID | O20241001000921 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326871807 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | James Scott Creighton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962552455 PECOS PAC ID: 7810342268 Enrollment ID: I20231005000297 |
| Provider Name | Cottrell Lamar Jacobs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467713024 PECOS PAC ID: 1850738337 Enrollment ID: I20240319004004 |
| Provider Name | Melissa Romell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649882747 PECOS PAC ID: 6507308517 Enrollment ID: I20240605003887 |
| Provider Name | Maria Dsouza |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265090096 PECOS PAC ID: 5597296632 Enrollment ID: I20241001001087 |
| Provider Name | Brenda Rae Henning |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972942480 PECOS PAC ID: 5294266102 Enrollment ID: I20241002003793 |
| Provider Name | Blanca Maldonado-stevens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194286559 PECOS PAC ID: 0042741613 Enrollment ID: I20241007002833 |
| Provider Name | Shalanda Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336609924 PECOS PAC ID: 1153855085 Enrollment ID: I20241114000645 |
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