Organization
INSTNEUROPSYCHADVANCED HC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEWEY D ARCHER JR. MD (PRESIDENTCEO)
(337) 477-7091
Entity
Organization
Contact information
Practice address
2829 4TH AVE, 150, LAKE CHARLES, LA 70601-7887
(337) 477-7091
(337) 474-4552
Mailing address
2829 4TH AVE, 150, LAKE CHARLES, LA 70601-7887
(337) 477-7091
(337) 474-4552
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
ADC6247
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1551228
—
LA
Enumeration date
01/04/2007
Last updated
08/22/2020
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