Provider Demographics
NPI:1538500772
Name:MATHERNE, DENISE FAVARON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:FAVARON
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3604
Mailing Address - Country:US
Mailing Address - Phone:504-451-6539
Mailing Address - Fax:
Practice Address - Street 1:3349 RIDGELAKE DR STE 103
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3851
Practice Address - Country:US
Practice Address - Phone:504-315-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2232101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health