Provider Demographics
NPI:1497303317
Name:GAUTREAUX, SHAWN BOURGEOIS (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:BOURGEOIS
Last Name:GAUTREAUX
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WAUBAN AVE
Mailing Address - Street 2:
Mailing Address - City:SCHRIEVER
Mailing Address - State:LA
Mailing Address - Zip Code:70395-4104
Mailing Address - Country:US
Mailing Address - Phone:985-492-0378
Mailing Address - Fax:
Practice Address - Street 1:106 WAUBAN AVE
Practice Address - Street 2:
Practice Address - City:SCHRIEVER
Practice Address - State:LA
Practice Address - Zip Code:70395-4104
Practice Address - Country:US
Practice Address - Phone:985-492-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health