Provider Demographics
NPI:1518342310
Name:DECLOUET, MATTHEW ALEXANDER (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:DECLOUET
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08470363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2411608Medicaid