Provider Demographics
NPI:1093390395
Name:ALLEN, EMILIE (LPC)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-0165
Mailing Address - Country:US
Mailing Address - Phone:985-879-3966
Mailing Address - Fax:
Practice Address - Street 1:102 W 2ND ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3004
Practice Address - Country:US
Practice Address - Phone:985-879-3966
Practice Address - Fax:985-872-4473
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health