# SOUTHERN PSYCHIATRIC SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992467641
- **Authorized official:** BRENNAN BERGERON (OWNER)
- **Authorized official phone:** (337) 480-7800

## Contact information

- **Practice address:** 7490 BUCKSKIN DR, IOWA, LA 70647-4429
- **Practice address phone:** (337) 540-7436
- **Mailing address:** 2829 4TH AVE STE 150, LAKE CHARLES, LA 70601-7897

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/11/2021
- **Last updated:** 10/20/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 12345 | — | LA |