Provider Demographics
NPI:1588483176
Name:PRESTRIDGE, TED ALLAN JR
Entity type:Individual
Prefix:
First Name:TED
Middle Name:ALLAN
Last Name:PRESTRIDGE
Suffix:JR
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 1:161 COMEAUX RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-7554
Mailing Address - Country:US
Mailing Address - Phone:318-516-0624
Mailing Address - Fax:
Practice Address - Street 1:161 COMEAUX RD
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-7554
Practice Address - Country:US
Practice Address - Phone:318-303-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)