Southern Psychiatric Services LLC
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Iowa, LA
NPI 1992467641 · NPPES record last updated Oct 20, 2022
Key facts
- NPI
- 1992467641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 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
- Organization subpart
- No
Authorized official
- Name
- Brennan Bergeron
- Title
- Owner
- Phone
- (337) 480-7800
Practitioners 1
-
Brennan Bergeron, APRN, PMHNP-BC
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | Yes |
Addresses
Primary practice location
7490 Buckskin Dr
Iowa, LA 70647-4429
Mailing address
2829 4TH Ave Ste 150
Lake Charles, LA 70601-7897
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12345 | Medicaid | LA |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.