Provider Demographics
NPI:1689124687
Name:BLANCHARD, ALYSE BARKER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALYSE
Middle Name:BARKER
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALYSE
Other - Middle Name:ANN
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 RUE MARGUERITE
Mailing Address - Street 2:SUITE A
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6746
Mailing Address - Country:US
Mailing Address - Phone:985-625-0023
Mailing Address - Fax:985-625-0022
Practice Address - Street 1:142 RUE MARGUERITE
Practice Address - Street 2:SUITE A
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6708
Practice Address - Country:US
Practice Address - Phone:985-625-0023
Practice Address - Fax:985-625-0022
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1343103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical