Provider Demographics
NPI:1043787302
Name:FOCH LABOVE, COURTNEY E (RD)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:E
Last Name:FOCH LABOVE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8528
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:1727 IMPERIAL BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5392
Practice Address - Country:US
Practice Address - Phone:337-310-3670
Practice Address - Fax:337-421-1408
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2694133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered