Provider Demographics
NPI:1558006668
Name:BLUE, DAMARA MALBRUE (LPC)
Entity type:Individual
Prefix:
First Name:DAMARA
Middle Name:MALBRUE
Last Name:BLUE
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 1:1801 MANHATTAN BLVD STE J224
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-7300
Mailing Address - Country:US
Mailing Address - Phone:504-710-1470
Mailing Address - Fax:
Practice Address - Street 1:520 MYRTLE DR APT 2206
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8266
Practice Address - Country:US
Practice Address - Phone:504-710-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7959101Y00000X, 101YM0800X, 101YS0200X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool