Provider Demographics
NPI:1619946001
Name:GUILLAUME, LIONEL (MD)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:GUILLAUME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 OLD MINDEN RD
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2476
Mailing Address - Country:US
Mailing Address - Phone:318-747-1665
Mailing Address - Fax:318-747-1597
Practice Address - Street 1:3018 OLD MINDEN RD
Practice Address - Street 2:SUITE 1212
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2495
Practice Address - Country:US
Practice Address - Phone:318-747-1665
Practice Address - Fax:318-747-1597
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0170322084P0800X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1343765Medicaid
LA52593Medicare ID - Type Unspecified
LA1343765Medicaid