1699083261 NPI number — MICHAEL BERARD, PH.D., M.P., A PROFESSIONAL PSYCHOLOGY CORPORATION

Table of content: (NPI 1699083261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699083261 NPI number — MICHAEL BERARD, PH.D., M.P., A PROFESSIONAL PSYCHOLOGY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL BERARD, PH.D., M.P., A PROFESSIONAL PSYCHOLOGY CORPORATION
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:
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:
1699083261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52612
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70505-2612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-233-7867
Provider Business Mailing Address Fax Number:
337-235-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 W SAINT MARY BLVD
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-3568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-233-7867
Provider Business Practice Location Address Fax Number:
337-235-7199
Provider Enumeration Date:
09/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BERARD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL PSYCHOLOGIST
Authorized Official Telephone Number:
337-233-7867

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X , with the licence number:  MPAP.000010 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: MPAP.000010 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP0016X , with the licence number: MPAP.000010 , 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)

  • Identifier: 1929191 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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