Provider Demographics
NPI:1427738442
Name:AVERETTE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:AVERETTE PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CEDRINA
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:AVERETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:337-534-0727
Mailing Address - Street 1:105 CANE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-7763
Mailing Address - Country:US
Mailing Address - Phone:504-421-4777
Mailing Address - Fax:337-534-0737
Practice Address - Street 1:3312 KALISTE SALOOM RD BLDG 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7449
Practice Address - Country:US
Practice Address - Phone:337-534-0727
Practice Address - Fax:337-534-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty