Provider Demographics
NPI:1518182633
Name:LEBLANC, CHRIS S (PHD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:S
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3850
Mailing Address - Street 2:23515 HWY 190
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-3850
Mailing Address - Country:US
Mailing Address - Phone:985-626-6300
Mailing Address - Fax:985-626-6467
Practice Address - Street 1:23515 HWY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70470-3850
Practice Address - Country:US
Practice Address - Phone:985-626-6300
Practice Address - Fax:985-626-6467
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA479103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1043264251OtherNPI FACILITY