Provider Demographics
NPI:1346890498
Name:BERTRAND, SHALACEY (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SHALACEY
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4119
Mailing Address - Country:US
Mailing Address - Phone:318-514-8893
Mailing Address - Fax:
Practice Address - Street 1:206 E REYNOLDS DR STE F2
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2809
Practice Address - Country:US
Practice Address - Phone:318-514-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health