Provider Demographics
NPI:1003047994
Name:DR TERRELL S MANUEL LLC
Entity Type:Organization
Organization Name:DR TERRELL S MANUEL LLC
Other - Org Name:PSYCHIATRIC CONSULTANTS OF LOUISIANA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP, PMHN
Authorized Official - Phone:337-298-8293
Mailing Address - Street 1:PO BOX 82570
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-2570
Mailing Address - Country:US
Mailing Address - Phone:337-298-8293
Mailing Address - Fax:
Practice Address - Street 1:12038 GREENWELL SPRINGS PORT HUDSON ROAD
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-654-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04812363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1810266Medicaid
LA1810266Medicaid