Provider Demographics
NPI:1326489709
Name:MELANCON, SARAH ESTELLE (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ESTELLE
Last Name:MELANCON
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MARYVIEW FARM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-4715
Mailing Address - Country:US
Mailing Address - Phone:337-515-2061
Mailing Address - Fax:
Practice Address - Street 1:409 MARYVIEW FARM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-4715
Practice Address - Country:US
Practice Address - Phone:337-515-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional