Provider Demographics
NPI:1700021102
Name:HEATHER PREJEAN LCSW, INC
Entity Type:Organization
Organization Name:HEATHER PREJEAN LCSW, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:PREJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-258-5214
Mailing Address - Street 1:240 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-2562
Mailing Address - Country:US
Mailing Address - Phone:337-258-5214
Mailing Address - Fax:337-785-1188
Practice Address - Street 1:318 E PARK ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2468
Practice Address - Country:US
Practice Address - Phone:337-258-5214
Practice Address - Fax:337-785-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-13
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA72441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793001Medicaid
LA5DG12Medicare PIN
LA5DG79Medicare PIN