Provider Demographics
NPI:1174004485
Name:BABB, MARIELLE (LPC)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:BABB
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 1:143 RIDGEWAY DR STE 228
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3410
Mailing Address - Country:US
Mailing Address - Phone:337-381-2019
Mailing Address - Fax:337-205-9635
Practice Address - Street 1:143 RIDGEWAY DR STE 228
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3410
Practice Address - Country:US
Practice Address - Phone:337-381-2019
Practice Address - Fax:337-205-9635
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health