Provider Demographics
NPI:1083736870
Name:LANDRY, LORRAINE FONTENOT (LPC LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:FONTENOT
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:MRS
Other - First Name:LORRAINE
Other - Middle Name:FONTENOT
Other - Last Name:PREJEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:17397 TIGER RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-6035
Mailing Address - Country:US
Mailing Address - Phone:225-622-2672
Mailing Address - Fax:225-622-3983
Practice Address - Street 1:17397 TIGER RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-6035
Practice Address - Country:US
Practice Address - Phone:225-622-2672
Practice Address - Fax:225-622-3983
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC 1783101YM0800X
LALMFT 196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900H2239ZOtherBLUE CROSS BLUE SHIELD
38940OtherNCC