Provider Demographics
NPI:1952485567
Name:LANCLOS, NICOLE F (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:F
Last Name:LANCLOS
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 1:332 HIGHWAY 1252
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5303
Mailing Address - Country:US
Mailing Address - Phone:318-613-1023
Mailing Address - Fax:
Practice Address - Street 1:3419 NW EVANGELINE TRWY STE M-5
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6241
Practice Address - Country:US
Practice Address - Phone:337-205-3388
Practice Address - Fax:337-703-0636
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA988103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent