Provider Demographics
NPI:1356966899
Name:BERGERON, CAREY (LPC)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9721 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1915
Mailing Address - Country:US
Mailing Address - Phone:504-315-9595
Mailing Address - Fax:
Practice Address - Street 1:9721 PAULA DR
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-1915
Practice Address - Country:US
Practice Address - Phone:504-315-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional