Provider Demographics
NPI:1902191851
Name:WAGUESPACK, CLAIRE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:
Last Name:WAGUESPACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CLAIRE
Other - Last Name:WAGUESPACK (FENTON)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5599 HWY 311
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-857-3615
Mailing Address - Fax:985-857-3706
Practice Address - Street 1:5599 HWY 311
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-857-3615
Practice Address - Fax:985-857-3706
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5014101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)