Provider Demographics
NPI:1598126351
Name:ACADIANA MEDICAL PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ACADIANA MEDICAL PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ECKHOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MP
Authorized Official - Phone:337-889-5830
Mailing Address - Street 1:93 MAGNATE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3840
Mailing Address - Country:US
Mailing Address - Phone:337-889-5830
Mailing Address - Fax:337-889-5834
Practice Address - Street 1:93 MAGNATE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3840
Practice Address - Country:US
Practice Address - Phone:337-889-5830
Practice Address - Fax:337-889-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty