Provider Demographics
NPI:1366011884
Name:DECLOUET MENTAL HEALTH SOLUTIONS, LLC
Entity Type:Organization
Organization Name:DECLOUET MENTAL HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:DECLOUET
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:337-280-0441
Mailing Address - Street 1:302 LA RUE FRANCE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3133
Mailing Address - Country:US
Mailing Address - Phone:337-534-0971
Mailing Address - Fax:337-534-0974
Practice Address - Street 1:302 LA RUE FRANCE STE 202
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3133
Practice Address - Country:US
Practice Address - Phone:337-534-0971
Practice Address - Fax:337-534-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-19
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty