Provider Demographics
NPI:1508297193
Name:SEASTRUNK, MICKIE (LPC-S)
Entity Type:Individual
Prefix:
First Name:MICKIE
Middle Name:
Last Name:SEASTRUNK
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 1:104 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4014
Mailing Address - Country:US
Mailing Address - Phone:337-238-0814
Mailing Address - Fax:
Practice Address - Street 1:104 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4014
Practice Address - Country:US
Practice Address - Phone:337-238-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health