Provider Demographics
NPI:1013552801
Name:SONNIER, MYA TENAE
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:TENAE
Last Name:SONNIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7887
Mailing Address - Country:US
Mailing Address - Phone:337-477-7091
Mailing Address - Fax:337-474-4552
Practice Address - Street 1:200 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3816
Practice Address - Country:US
Practice Address - Phone:337-437-4014
Practice Address - Fax:337-437-8283
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
LA18015104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1551228Medicaid