Provider Demographics
NPI:1013742147
Name:INJETI, MADHULIKA
Entity type:Individual
Prefix:
First Name:MADHULIKA
Middle Name:
Last Name:INJETI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 PRINCETON WOODS LOOP
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6604
Mailing Address - Country:US
Mailing Address - Phone:504-908-1412
Mailing Address - Fax:
Practice Address - Street 1:516 VEROT SCHOOL RD STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5026
Practice Address - Country:US
Practice Address - Phone:337-703-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health