Provider Demographics
NPI:1528523271
Name:VERRETT, MARK AARON SR
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:AARON
Last Name:VERRETT
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4240
Mailing Address - Country:US
Mailing Address - Phone:504-319-5096
Mailing Address - Fax:
Practice Address - Street 1:1799 STUMPF BLVD STE 6
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:504-510-3555
Practice Address - Fax:504-571-5202
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health