Provider Demographics
NPI:1740871565
Name:LYNETTE HESLET PHD MP
Entity type:Organization
Organization Name:LYNETTE HESLET PHD MP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HESLET
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MP
Authorized Official - Phone:985-445-1444
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-0085
Mailing Address - Country:US
Mailing Address - Phone:337-643-8424
Mailing Address - Fax:337-643-8407
Practice Address - Street 1:700 GAUSE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2854
Practice Address - Country:US
Practice Address - Phone:985-445-1444
Practice Address - Fax:985-445-1285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYNETTE HESLET
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1035203Medicaid