Provider Demographics
NPI:1386193738
Name:BELLARD, ALEXIS
Entity Type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:
Last Name:BELLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 LOUISA DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-8758
Mailing Address - Country:US
Mailing Address - Phone:337-499-5522
Mailing Address - Fax:
Practice Address - Street 1:247 W SALLIER ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5843
Practice Address - Country:US
Practice Address - Phone:337-602-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health