Provider Demographics
NPI:1376645903
Name:ELDRIDGE, GARRY L (LPC; LMFT)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:L
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:LPC; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 POYDRAS ST
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-6101
Mailing Address - Country:US
Mailing Address - Phone:504-259-6889
Mailing Address - Fax:504-525-1488
Practice Address - Street 1:650 POYDRAS ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-6101
Practice Address - Country:US
Practice Address - Phone:504-259-6889
Practice Address - Fax:504-525-1488
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1381101YM0800X, 101YP2500X
3584101YP1600X
LA625106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist