Provider Demographics
NPI:1295922490
Name:PREJEAN, HEATHER R (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:PREJEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA72441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CG12OtherMEDICARE GROUP PTAN
LA1793001Medicaid
LA5DG12Medicare PIN
LA5DG79Medicare PIN