Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Psychiatric/Mental Health, Adult |
364SP0809X | 89 | Certified Clinical Nurse Specialist |
| NPI # | 1609248376 |
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| LBN Legal business name | DECLOUET PSYCHIATRIC SERVICES, LLC | ||||
| Authorized official | MATTHEW DECLOUET - (NURSE PRACTITIONER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 10/21/2015 | ||||
| Last updated | 06/08/2016 - About 10 years ago | ||||
| Identifiers |
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