| Instneuropsychadvanced Hc | |
|
2829 4th Ave 150 Lake Charles LA 70601-7887 | |
| (337) 477-7091 | |
| (337) 474-4552 |
| Full Name | Instneuropsychadvanced Hc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2829 4th Ave, Lake Charles, Louisiana |
| Authorized Official Name and Position | Dewey D Archer (PRESIDENTCEO) |
| Authorized Official Contact | 3374777091 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Instneuropsychadvanced Hc 2829 4th Ave 150 Lake Charles LA 70601-7887 Ph: (337) 477-7091 | Instneuropsychadvanced Hc 2829 4th Ave 150 Lake Charles LA 70601-7887 Ph: (337) 477-7091 |
| NPI Number | 1063569648 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063569648 | NPI | - | NPPES |
| 1551228 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | ADC6247 (Louisiana) | Primary |
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