Provider Demographics
NPI:1992443469
Name:THIBODEAUX, MICHELE M (LCSW-BACS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:THIBODEAUX
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8448 STEVE RD
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-6437
Mailing Address - Country:US
Mailing Address - Phone:133-750-1869
Mailing Address - Fax:
Practice Address - Street 1:120 S STATE ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5149
Practice Address - Country:US
Practice Address - Phone:337-513-0822
Practice Address - Fax:337-202-2376
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical