Provider Demographics
NPI:1245309046
Name:INSTITUTE FOR NEUROPSYCHIATRY,APMC
Entity type:Organization
Organization Name:INSTITUTE FOR NEUROPSYCHIATRY,APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-477-7091
Mailing Address - Street 1:2829 4TH AVE
Mailing Address - Street 2:STE. 150
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7887
Mailing Address - Country:US
Mailing Address - Phone:337-477-7091
Mailing Address - Fax:337-474-4552
Practice Address - Street 1:2829 4TH AVE
Practice Address - Street 2:150
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7887
Practice Address - Country:US
Practice Address - Phone:337-477-7091
Practice Address - Fax:337-474-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X
LA2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1945901Medicaid
LA57563Medicare ID - Type Unspecified