1104966696 NPI number — MR. PATRICK HEBERT LCSW #10194

Table of content: MR. PATRICK HEBERT LCSW #10194 (NPI 1104966696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104966696 NPI number — MR. PATRICK HEBERT LCSW #10194

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEBERT
Provider First Name:
PATRICK
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW #10194
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104966696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1476 , 507 PERRY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IOWA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70647-1476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-274-2452
Provider Business Mailing Address Fax Number:
337-475-3105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3505 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70607-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-475-4861
Provider Business Practice Location Address Fax Number:
337-475-3105
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  10194 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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