Provider Demographics
NPI:1013274901
Name:THIBODEAUX, DENISE AMIE (MED, NCC, LPC, LAC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:AMIE
Last Name:THIBODEAUX
Suffix:
Gender:F
Credentials:MED, NCC, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7384 JOHN LEBLANC BLVD
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:LA
Mailing Address - Zip Code:70778-3231
Mailing Address - Country:US
Mailing Address - Phone:225-330-9328
Mailing Address - Fax:
Practice Address - Street 1:7384 JOHN LEBLANC BLVD
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:LA
Practice Address - Zip Code:70778-3231
Practice Address - Country:US
Practice Address - Phone:225-300-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC 4943101YM0800X, 101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health