Provider Demographics
NPI:1346760972
Name:NAQUIN, GLENN LOUIS JR (LAC, NRP)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:LOUIS
Last Name:NAQUIN
Suffix:JR
Gender:M
Credentials:LAC, NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-5318
Mailing Address - Country:US
Mailing Address - Phone:985-262-7224
Mailing Address - Fax:
Practice Address - Street 1:264 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-5318
Practice Address - Country:US
Practice Address - Phone:985-262-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA14-95911146L00000X
LA1594101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty