Provider Demographics
NPI:1619004397
Name:MELDA-CLAUDE PROFESSIONAL COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:MELDA-CLAUDE PROFESSIONAL COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LMFT, NCC
Authorized Official - Phone:985-652-2052
Mailing Address - Street 1:425 W AIRLINE HWY STE D UPPER
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3825
Mailing Address - Country:US
Mailing Address - Phone:985-652-2052
Mailing Address - Fax:225-869-8049
Practice Address - Street 1:425 W AIRLINE HWY STE D UPPER
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3825
Practice Address - Country:US
Practice Address - Phone:985-652-2052
Practice Address - Fax:225-869-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC 1963101YP2500X
LALMFT 247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty