Most Relevant Information
Provider Data
| NPI Number: | 1003338401 |
| Provider Name: | PETER BRIAN DEROUEN |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/07/2017 |
| Last Updated: | 07/07/2017 |
Provider Practice Location
160 INDUSTRIAL PKWY STE 105
LAFAYETTE
LA
705088309
Practice Location Phone/Fax
| Phone: | 3372980990 |
| Fax: |
Provider Mailing Location
PO BOX 61592
LAFAYETTE
LA
705961592
Provider Mailing Phone/Fax
| Phone: | |
| Fax: | 3372140779 |