Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
GLENDA GRAVOUILLA POULAN, LRST
Active Sole ProprietorGLENDA GRAVOUILLA POULAN, LRST is a Behavioral Health, Residential healthcare provider located in LAFAYETTE, Louisiana. NPI 1447742473 is currently active in the NPPES registry. Verify at CMS.
Behavioral Health, Residential · LAFAYETTE, LA
Registration Details
- NPI Number
- 1447742473
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jun 5, 2018 (8.2241978778073 yrs)
- Last Updated
- Jun 13, 2018
- Sole Proprietor
- Yes
Practice Information
- Address
-
330 GUILBEAU RDLAFAYETTE, LA, 70506Browse LA providers · Browse ZIP 70506
- Phone
- 3724752473
- Fax
- 2146024526
- Primary Specialty
-
Behavioral Health, Residential
251C00000X
- Additional Specialty
- Behavioral Health, Residential
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.