Provider Demographics
NPI:1669917878
Name:LEFORT, MICHAEL (MED, LPC-S)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LEFORT
Suffix:
Gender:M
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16036 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-3508
Mailing Address - Country:US
Mailing Address - Phone:985-632-2569
Mailing Address - Fax:985-325-8668
Practice Address - Street 1:16036 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-3508
Practice Address - Country:US
Practice Address - Phone:985-632-2569
Practice Address - Fax:985-325-8668
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional