Provider Demographics
NPI:1598299828
Name:PREJEAN, AMBER (LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PREJEAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:502 PLAZA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5118
Mailing Address - Country:US
Mailing Address - Phone:985-312-9018
Mailing Address - Fax:
Practice Address - Street 1:101 TEURLINGS DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3832
Practice Address - Country:US
Practice Address - Phone:337-889-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7156101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor