Provider Demographics
NPI:1942345491
Name:DIEDRICH, NANCY O (LPC, LMFT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:O
Last Name:DIEDRICH
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 ASHLAND DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2904
Mailing Address - Country:US
Mailing Address - Phone:985-686-0432
Mailing Address - Fax:
Practice Address - Street 1:423 GOODE ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4515
Practice Address - Country:US
Practice Address - Phone:985-686-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1657 (LPC)101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health