Provider Demographics
NPI:1699083261
Name:MICHAEL BERARD, PH.D., M.P., A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:MICHAEL BERARD, PH.D., M.P., A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPAP
Authorized Official - Phone:337-233-7867
Mailing Address - Street 1:PO BOX 52612
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2612
Mailing Address - Country:US
Mailing Address - Phone:337-233-7867
Mailing Address - Fax:337-235-7199
Practice Address - Street 1:601 W SAINT MARY BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3568
Practice Address - Country:US
Practice Address - Phone:337-233-7867
Practice Address - Fax:337-235-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMPAP.000010103TB0200X, 103TC0700X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1929191Medicaid
LA59421Medicare PIN