Provider Demographics
NPI:1689318206
Name:DYER PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:DYER PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KALA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-422-6731
Mailing Address - Street 1:748 BAYOU PINES EAST DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7596
Mailing Address - Country:US
Mailing Address - Phone:337-422-6731
Mailing Address - Fax:
Practice Address - Street 1:748 BAYOU PINES EAST DR STE C
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7596
Practice Address - Country:US
Practice Address - Phone:337-422-6731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty