Provider Demographics
NPI:1659495521
Name:LENOX, STACI GUIDRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:GUIDRY
Last Name:LENOX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 W. CONGRESS ST.
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-235-8304
Mailing Address - Fax:337-235-5924
Practice Address - Street 1:4212 W. CONGRESS ST.
Practice Address - Street 2:SUITE 3500
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-235-8304
Practice Address - Fax:337-235-5924
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA746103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1682535Medicaid