Provider Demographics
NPI:1508221979
Name:OUBRE, RENISHA CECILIA (MED, PLPC)
Entity Type:Individual
Prefix:MISS
First Name:RENISHA
Middle Name:CECILIA
Last Name:OUBRE
Suffix:
Gender:F
Credentials:MED, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22795 HIGH RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090
Mailing Address - Country:US
Mailing Address - Phone:986-713-6353
Mailing Address - Fax:225-265-2170
Practice Address - Street 1:COGNITIVE DEVELOPMENT CENTER
Practice Address - Street 2:576 BELLE TERRE BLVD.
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:504-492-2271
Practice Address - Fax:985-359-2399
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5367101YM0800X, 101YP2500X
101YP2500X, 171M00000X
LALEVEL 3: 521315101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator