Provider Demographics
NPI:1689768012
Name:LE BEAU, ROXANNE NOELLE (MA, LPC, CADC)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:NOELLE
Last Name:LE BEAU
Suffix:
Gender:F
Credentials:MA, LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MOUND AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-3350
Mailing Address - Country:US
Mailing Address - Phone:262-633-3591
Mailing Address - Fax:262-633-2619
Practice Address - Street 1:1220 MOUND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-3350
Practice Address - Country:US
Practice Address - Phone:262-633-3591
Practice Address - Fax:262-633-2619
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21984101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21984OtherCADC
WI40961600Medicaid