1427738442 NPI number — AVERETTE PSYCHOLOGICAL SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427738442 NPI number — AVERETTE PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVERETTE PSYCHOLOGICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CEDRINA K AVERETTE PHD
Provider Other Organization Name Type Code:
3
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:
1427738442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 CANE CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROUSSARD
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70518-7763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-421-4777
Provider Business Mailing Address Fax Number:
337-534-0737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3312 KALISTE SALOOM RD BLDG 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508-7449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-534-0727
Provider Business Practice Location Address Fax Number:
337-534-0737
Provider Enumeration Date:
07/24/2023

Additional Information

Authorized Official

Authorized Official Last Name:
AVERETTE
Authorized Official First Name:
CEDRINA
Authorized Official Middle Name:
KNIGHT
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
337-534-0727

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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