Provider Demographics
NPI:1053861302
Name:DESPANIE, ERIN JENTRAY
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JENTRAY
Last Name:DESPANIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W SOUTH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5100
Mailing Address - Country:US
Mailing Address - Phone:337-323-9608
Mailing Address - Fax:
Practice Address - Street 1:303 W SOUTH ST
Practice Address - Street 2:APT. 1
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5100
Practice Address - Country:US
Practice Address - Phone:337-323-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health