Provider Demographics
NPI:1558976084
Name:DECLOUET, ALYSSA (PMHNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DECLOUET
Suffix:
Gender:F
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:2020-09-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP214832363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health