Provider Demographics
NPI:1609100676
Name:BILLUPS, THERESA DUMAS (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DUMAS
Last Name:BILLUPS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 RIVERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-7716
Mailing Address - Country:US
Mailing Address - Phone:337-478-1931
Mailing Address - Fax:
Practice Address - Street 1:116 STATE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5718
Practice Address - Country:US
Practice Address - Phone:337-478-1616
Practice Address - Fax:337-478-1632
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional