Southern Psychiatric Services LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SOUTHERN PSYCHIATRIC SERVICES LLC

Practice address

7490 Buckskin Dr
Iowa, LA 70647-4429

Phone

(337) 540-7436

NPI assigned

Oct 11, 2021

Last updated

Oct 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brennan BergeronNPI 1982370045

Title

Owner

Phone

(337) 480-7800

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brennan Bergeron, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lake Charles, LA
  • NPI 1982370045
  NPD Authorized official

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

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1992467641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 4TH AVE STE 150",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7490 BUCKSKIN DR",
            "city": "IOWA",
            "state": "LA",
            "postal_code": "706474429",
            "telephone_number": "337-540-7436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PSYCHIATRIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-11",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "BERGERON",
        "authorized_official_first_name": "BRENNAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-480-7800"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12345",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Iowa, LA
• Providers in Iowa, LA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.