Provider Demographics
NPI:1689868234
Name:BUSINELLE, MICKEY GUDON (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:GUDON
Last Name:BUSINELLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-4720
Mailing Address - Country:US
Mailing Address - Phone:337-788-7511
Mailing Address - Fax:
Practice Address - Street 1:1822 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4720
Practice Address - Country:US
Practice Address - Phone:337-788-7511
Practice Address - Fax:337-788-4905
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional