Provider Demographics
NPI:1336519628
Name:PREJEAN, STACY (LMT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:PREJEAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-0851
Mailing Address - Country:US
Mailing Address - Phone:337-384-2929
Mailing Address - Fax:
Practice Address - Street 1:123 E 3RD ST
Practice Address - Street 2:ROOM 134
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-5100
Practice Address - Country:US
Practice Address - Phone:337-384-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA7893225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist