NPIMap

Organization Active NPI

Psychological Health Care of South Louisiana

  • Clinical Neuropsychologist
  • Houma, LA
National Provider Identifier
1134418502
Registry record updated Apr 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
895 Issued in LA
Legal business name
PSYCHOLOGICAL HEALTH CARE OF SOUTH LOUISIANA
Practice address
1016 Houma St
Houma, LA 70360-4420
Phone
(985) 859-5455
Fax
(985) 859-5455
NPI assigned
Apr 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth Christopher Rachal, PHD, MPNPI 1871590067
Title
President
Phone
(985) 859-5455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X 895 LA Primary
Prescribing (Medical) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP0016X MP.0014 LA

Addresses

Primary practice location

1016 Houma St
Houma, LA 70360-4420

Mailing address

1016 Houma St
Houma, LA 70360-4420
Phone (985) 859-5455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110920000249 LA Part B Supplier - Clinic/Group Practice 5395916571 Receives reassigned benefits from 8 practitioners
Practice locations: Thibodaux, LA

National Provider Directory

National Provider Directory

Locations

1016 Houma St
Houma, LA 70360
Phone (985) 859-5455

126 Rue Colette
Thibodaux, LA 70301
Phone (985) 625-0023

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302048000000",
    "number": "1134418502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 HOUMA ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703604420",
            "telephone_number": "985-859-5455",
            "fax_number": "985-859-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 HOUMA ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703604420",
            "telephone_number": "985-859-5455",
            "fax_number": "985-859-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL HEALTH CARE OF SOUTH LOUISIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-06",
        "last_updated": "2011-04-06",
        "status": "A",
        "authorized_official_last_name": "RACHAL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "985-859-5455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, MP"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "LA",
            "license": "895",
            "primary": true
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "LA",
            "license": "MP.0014",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houma, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.