Provider Demographics
NPI:1326304619
Name:LEDET, LATON FRYE (LSCW)
Entity Type:Individual
Prefix:MRS
First Name:LATON
Middle Name:FRYE
Last Name:LEDET
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2777
Mailing Address - Country:US
Mailing Address - Phone:985-209-6250
Mailing Address - Fax:985-876-5551
Practice Address - Street 1:5 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2777
Practice Address - Country:US
Practice Address - Phone:985-209-6250
Practice Address - Fax:985-875-5551
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA66171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA14097083OtherCAQH