Provider Demographics
NPI:1831559822
Name:BLUEPRINT HORMONE AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:BLUEPRINT HORMONE AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-230-9266
Mailing Address - Street 1:345 DOUCET RD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3488
Mailing Address - Country:US
Mailing Address - Phone:337-230-9266
Mailing Address - Fax:
Practice Address - Street 1:345 DOUCET RD
Practice Address - Street 2:SUITE 229
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3488
Practice Address - Country:US
Practice Address - Phone:337-230-9266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1065909#CFT93207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty