Provider Demographics
NPI:1366477473
Name:THIBODAUX, BERNADETTE (LAC, CCGC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:THIBODAUX
Suffix:
Gender:F
Credentials:LAC, CCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LEGION AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3339
Mailing Address - Country:US
Mailing Address - Phone:985-857-3612
Mailing Address - Fax:985-857-3782
Practice Address - Street 1:521 LEGION AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3339
Practice Address - Country:US
Practice Address - Phone:985-857-3612
Practice Address - Fax:985-857-3782
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA108101Y00000X
LA581101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor