Provider Demographics
NPI:1134179500
Name:LAMOUREUX, ALBERT W (LMHC)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:W
Last Name:LAMOUREUX
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6034 CHESTER AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2264
Mailing Address - Country:US
Mailing Address - Phone:904-448-5521
Mailing Address - Fax:904-448-5524
Practice Address - Street 1:6034 CHESTER AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2266
Practice Address - Country:US
Practice Address - Phone:904-448-5521
Practice Address - Fax:904-448-5524
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762686000Medicaid