Provider Demographics
NPI:1558958397
Name:PEDEN, VIRGINIA CATHERINE JENSEN (PLMFT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CATHERINE JENSEN
Last Name:PEDEN
Suffix:
Gender:F
Credentials:PLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25134 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-4514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21516 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3906
Practice Address - Country:US
Practice Address - Phone:985-273-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLM1398106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist