Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 541 | LA |
N | 103TC0700X | Clinical Psychologist | 541 | LA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 541 | LA |
N | 103G00000X | Clinical Psychologist | 541 | LA |
N | 103TC0700X | Clinical Psychologist | 541 | LA |
N | 103TF0200X | Forensic Psychologist | 541 | LA |
N | 103TP2701X | Group Psychotherapist | 541 | LA |
NPI | 1316978935 |
---|---|
Provider Name | Dr. Larry James Benoit |
First Address | Lafayette, LA 70501-7807 |
Second Address | Lafayette, LA 70501-7807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |