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Organization
SOUTHERN PSYCHIATRIC SERVICES LLC
Active
Organization
SOUTHERN PSYCHIATRIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENNAN BERGERON (OWNER)
(337) 480-7800
Entity
Organization
Contact information
Practice address
7490 BUCKSKIN DR, IOWA, LA 70647-4429
(337) 540-7436
Mailing address
2829 4TH AVE STE 150, LAKE CHARLES, LA 70601-7897
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12345
—
LA
Enumeration date
10/11/2021
Last updated
10/20/2022
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