Provider Demographics
NPI:1073968608
Name:JOSEPH, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 TURTLEREEK LANE
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087
Mailing Address - Country:US
Mailing Address - Phone:504-338-1108
Mailing Address - Fax:
Practice Address - Street 1:608 TURTLE CREEK LN
Practice Address - Street 2:
Practice Address - City:SAINT ROSE
Practice Address - State:LA
Practice Address - Zip Code:70087-3830
Practice Address - Country:US
Practice Address - Phone:504-338-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9391531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health