Provider Demographics
NPI:1639222409
Name:MAILLET, SUSAN LAFARGUE (MHC COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LAFARGUE
Last Name:MAILLET
Suffix:
Gender:F
Credentials:MHC COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:694 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2945
Mailing Address - Country:US
Mailing Address - Phone:318-253-9638
Mailing Address - Fax:318-253-6354
Practice Address - Street 1:694 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2945
Practice Address - Country:US
Practice Address - Phone:318-253-9638
Practice Address - Fax:318-253-6354
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health