Provider Demographics
NPI:1275338568
Name:BERRY, LACRYSTAL
Entity type:Individual
Prefix:MS
First Name:LACRYSTAL
Middle Name:
Last Name:BERRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HUDSON LN STE 139
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6037
Mailing Address - Country:US
Mailing Address - Phone:318-651-0086
Mailing Address - Fax:318-651-0087
Practice Address - Street 1:1401 HUDSON LN STE 139
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6037
Practice Address - Country:US
Practice Address - Phone:318-651-0086
Practice Address - Fax:318-651-0087
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator