Provider Demographics
NPI:1114549292
Name:HUVAL, MARY FONTENOT (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FONTENOT
Last Name:HUVAL
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 PEACH BLOOM HWY
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-3930
Mailing Address - Country:US
Mailing Address - Phone:337-258-9825
Mailing Address - Fax:337-534-8141
Practice Address - Street 1:850 KALISTE SALOOM RD STE 204
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4230
Practice Address - Country:US
Practice Address - Phone:337-534-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1497133508OtherPRIVATE INSURANCE COMPANY