| Psychological Health Care Of South Louisiana | |
|
1016 Houma St Houma LA 70360-4420 | |
| (985) 859-5455 | |
| (985) 859-5455 |
| Full Name | Psychological Health Care Of South Louisiana |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 1016 Houma St, Houma, Louisiana |
| Authorized Official Name and Position | Kenneth Christopher Rachal (PRESIDENT) |
| Authorized Official Contact | 9858595455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Health Care Of South Louisiana 1016 Houma St Houma LA 70360-4420 Ph: (985) 859-5455 | Psychological Health Care Of South Louisiana 1016 Houma St Houma LA 70360-4420 Ph: (985) 859-5455 |
| NPI Number | 1134418502 |
|---|---|
| Provider Enumeration Date | 04/06/2011 |
| Last Update Date | 04/06/2011 |
| Medicare PECOS PAC ID | 5395916571 |
|---|---|
| Medicare Enrollment ID | O20110920000249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134418502 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 895 (Louisiana) | Primary |
| 103TP0016X | Psychologist - Prescribing (medical) | MP.0014 (Louisiana) | Secondary |
| Provider Name | Kenneth C Rachal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871590067 PECOS PAC ID: 4385799444 Enrollment ID: I20090902000224 |
| Provider Name | Alyse Blanchard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689124687 PECOS PAC ID: 8527349364 Enrollment ID: I20170110000859 |
| Provider Name | Brittany Mire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093251472 PECOS PAC ID: 2668757469 Enrollment ID: I20170317000804 |
| Provider Name | Ryan Michael Kelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346855517 PECOS PAC ID: 4183044480 Enrollment ID: I20201026000500 |
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