Provider Information for 1467755124
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Mr. BENJAMIN TUCKER SAVANT MA, LPC
Sex: Male
NPI: 1467755124
Last Updated: 2022-07-07
Certification Date: 2022-05-17
Certification Date: 2022-05-17
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1467755124 | ||||||||
| Enumeration Date | 2010-12-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 748 BAYOU PINES EAST DR STE D LAKE CHARLES, LA 70601-7595 United States Phone: 337-707-7724 | Fax:337-625-6968 | ||||||||
| Primary Practice Address | 748 BAYOU PINES DRIVE EAST, STE. D LAKE CHARLES, LA 70601 United States Phone: 337-707-7724 | Fax:337-419-0490 | ||||||||
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