| |
3921 Independence Dr Ste 101 Alexandria LA 71303-3566 | |
(318) 528-8717 | |
(318) 528-8865 |
Full Name | |
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Speciality | Counselor |
Location | 3921 Independence Dr Ste 101, Alexandria, Louisiana |
Authorized Official Name and Position | Lydia T. Roy (OWNER) |
Authorized Official Contact | 3185288717 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3921 Independence Dr Ste 101 Alexandria LA 71303-3566 Ph: (318) 528-8717 | 3921 Independence Dr Ste 101 Alexandria LA 71303-3566 Ph: (318) 528-8717 |
NPI Number | 1093580243 |
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Provider Enumeration Date | 11/17/2023 |
Last Update Date | 01/26/2024 |
Certification Date | 01/26/2024 |
Medicare PECOS PAC ID | 3476905845 |
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Medicare Enrollment ID | O20240122002102 |
Identifier | Type | State | Issuer |
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1093580243 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Lydia Roy |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1740431568 PECOS PAC ID: 4385096759 Enrollment ID: I20240128000088 |
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