Provider Demographics
NPI:1083148506
Name:DENNIS, LAOTIS DEE (MHP, MSCJ)
Entity Type:Individual
Prefix:
First Name:LAOTIS
Middle Name:DEE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MHP, MSCJ
Other - Prefix:
Other - First Name:LAOTIS
Other - Middle Name:
Other - Last Name:NICKELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, MSCJ
Mailing Address - Street 1:3205 HWY 51
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAPLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068
Mailing Address - Country:US
Mailing Address - Phone:985-651-0020
Mailing Address - Fax:
Practice Address - Street 1:579 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084
Practice Address - Country:US
Practice Address - Phone:985-233-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA009462156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health