Provider Demographics
NPI:1285203844
Name:CLAVELLE, FRANK JR (ABD, PLPC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:CLAVELLE
Suffix:JR
Gender:M
Credentials:ABD, PLPC
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 652
Mailing Address - Street 2:
Mailing Address - City:BOUTTE
Mailing Address - State:LA
Mailing Address - Zip Code:70039-0652
Mailing Address - Country:US
Mailing Address - Phone:504-644-8953
Mailing Address - Fax:
Practice Address - Street 1:3301 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6247
Practice Address - Country:US
Practice Address - Phone:504-644-2575
Practice Address - Fax:504-644-2803
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC6994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health