Provider Demographics
NPI:1689031734
Name:GARAUDY, MYRIAH (MA)
Entity Type:Individual
Prefix:
First Name:MYRIAH
Middle Name:
Last Name:GARAUDY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 OLD NEW ORLEANS RD
Mailing Address - Street 2:
Mailing Address - City:DOWNSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71234-5767
Mailing Address - Country:US
Mailing Address - Phone:985-507-2713
Mailing Address - Fax:
Practice Address - Street 1:470 OLD NEW ORLEANS RD
Practice Address - Street 2:
Practice Address - City:DOWNSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71234
Practice Address - Country:US
Practice Address - Phone:985-507-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional