Provider Demographics
NPI:1659787190
Name:NAQUIN, RICHARD (RPH,LPC,LMFT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:NAQUIN
Suffix:
Gender:M
Credentials:RPH,LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 BLAKE CT
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3503
Mailing Address - Country:US
Mailing Address - Phone:504-913-8776
Mailing Address - Fax:
Practice Address - Street 1:519 BLAKE CT
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3503
Practice Address - Country:US
Practice Address - Phone:504-913-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-04
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10571183500000X
LA2218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No183500000XPharmacy Service ProvidersPharmacist