Provider Demographics
NPI:1215579438
Name:ROUSSEAU, MYEAKA (LPC)
Entity Type:Individual
Prefix:
First Name:MYEAKA
Middle Name:
Last Name:ROUSSEAU
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 1:150 RUE DUBOURG
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3444
Mailing Address - Country:US
Mailing Address - Phone:985-817-8170
Mailing Address - Fax:
Practice Address - Street 1:429 W AIRLINE HWY STE Q
Practice Address - Street 2:OFFICE 5
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3817
Practice Address - Country:US
Practice Address - Phone:985-210-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012460101YP2500X
LA6754101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional