Provider Demographics
NPI:1780786137
Name:ELLIOTT, LUKE SEXTON JR (PHD)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:SEXTON
Last Name:ELLIOTT
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 RIDGEWAY DR
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3446
Mailing Address - Country:US
Mailing Address - Phone:337-984-7614
Mailing Address - Fax:337-984-8696
Practice Address - Street 1:119 RIDGEWAY DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3446
Practice Address - Country:US
Practice Address - Phone:337-984-7614
Practice Address - Fax:337-984-8696
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA248103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20909OtherBLUE CROSS OF LA