Basic Information
| Provider Information | |||||||||
| NPI: | 1154893899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARCENEAUX | ||||||||
| FirstName: | SCOTTY | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 N LAHASKY ST | ||||||||
| Address2: | |||||||||
| City: | ERATH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705333009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375770710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 HEYMANN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375044279 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2018 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CIT-5308 | LA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 813855797 | 05 | LA | MEDICAID |