Provider Demographics
NPI:1568022499
Name:PELICHET, KIRKLAND
Entity type:Individual
Prefix:
First Name:KIRKLAND
Middle Name:
Last Name:PELICHET
Suffix:
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 1:415 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2747
Mailing Address - Country:US
Mailing Address - Phone:225-245-9070
Mailing Address - Fax:
Practice Address - Street 1:415 COURT ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2747
Practice Address - Country:US
Practice Address - Phone:225-245-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health