Provider Demographics
NPI:1699016428
Name:MATHIEU, MAYANCE JOSEPH JR (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:MAYANCE
Middle Name:JOSEPH
Last Name:MATHIEU
Suffix:JR
Gender:M
Credentials:MA, LPC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2733 RUE CANNES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4044
Mailing Address - Country:US
Mailing Address - Phone:337-540-3427
Mailing Address - Fax:337-436-8291
Practice Address - Street 1:7378 HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-4803
Practice Address - Country:US
Practice Address - Phone:337-436-7553
Practice Address - Fax:337-436-8291
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health