Provider Demographics
NPI:1689702185
Name:BUSTAMANTE, AIMEE J (MED , NCC, LPC)
Entity Type:Individual
Prefix:MISS
First Name:AIMEE
Middle Name:J
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:MED , NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-4001
Mailing Address - Country:US
Mailing Address - Phone:504-305-4704
Mailing Address - Fax:
Practice Address - Street 1:2200 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-4001
Practice Address - Country:US
Practice Address - Phone:504-305-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA79797101Y00000X
LA3356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor