Provider Demographics
NPI:1336686310
Name:GAUTHIER, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EDGARD
Mailing Address - State:LA
Mailing Address - Zip Code:70049-2531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EDGARD
Practice Address - State:LA
Practice Address - Zip Code:70049-2531
Practice Address - Country:US
Practice Address - Phone:985-288-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010154629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health