Doctor Name: | MRS. IVY DESIRAE BENNETT SIAS |
NPI Number: | 1659741999 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., NCC, LPC |
License Number: | 5550 |
Business Practice Address: | 1010 Auburn Ave Lafayette, LA - 705032308 |
Business Phone Number: | 3372329457 |
Business Fax Number: | 3372329459 |
Mailing Address: | 326 Saint Matthias Dr, CARENCRO |
State: | LA |
Postal Code: | 705205576 |
Phone Number: | 3104295025 |
Fax Number: | |
NPI Enumeration Date: | 09/29/2015 |
NPI Last Update Date: | 09/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 5550 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |