Provider Demographics
NPI:1609818418
Name:LECORGNE, LYLE LANNING (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:LANNING
Last Name:LECORGNE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 AUDUBON BLVD
Mailing Address - Street 2:SUITE 206-B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2676
Mailing Address - Country:US
Mailing Address - Phone:337-232-0060
Mailing Address - Fax:337-232-0062
Practice Address - Street 1:401 AUDUBON BLVD
Practice Address - Street 2:SUITE 206-B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2676
Practice Address - Country:US
Practice Address - Phone:337-232-0060
Practice Address - Fax:337-232-0062
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56092Medicare ID - Type UnspecifiedMEDICARE
LA56092Medicare PIN