Provider Demographics
NPI:1619613403
Name:BILLETDEOOUX, MARIEL (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARIEL
Middle Name:
Last Name:BILLETDEOOUX
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7525
Mailing Address - Country:US
Mailing Address - Phone:727-623-8959
Mailing Address - Fax:
Practice Address - Street 1:13119 W LINEBAUGH AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4494
Practice Address - Country:US
Practice Address - Phone:813-906-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health