Provider Demographics
NPI:1689263501
Name:EAVES, ANTHONY J JR (PLPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:EAVES
Suffix:JR
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3919
Mailing Address - Country:US
Mailing Address - Phone:225-276-9203
Mailing Address - Fax:
Practice Address - Street 1:1112 E ASCENSION COMPLEX BLVD # A
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4265
Practice Address - Country:US
Practice Address - Phone:225-450-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health