Provider Demographics
NPI:1235451568
Name:PRIORITY PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:PRIORITY PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:337-330-4730
Mailing Address - Street 1:PO BOX 1317
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-1317
Mailing Address - Country:US
Mailing Address - Phone:337-330-4730
Mailing Address - Fax:337-330-4732
Practice Address - Street 1:805 ALBERTSON PKWY STE A
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4350
Practice Address - Country:US
Practice Address - Phone:337-330-4730
Practice Address - Fax:337-330-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN094687-AP06057363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2100190Medicaid