Provider Demographics
NPI:1679010136
Name:GUILBEAUX, MAYA
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:GUILBEAUX
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 MANHATTAN BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5361
Mailing Address - Country:US
Mailing Address - Phone:504-364-8949
Mailing Address - Fax:504-364-8968
Practice Address - Street 1:2439 MANHATTAN BLVD STE 207
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5361
Practice Address - Country:US
Practice Address - Phone:504-364-8949
Practice Address - Fax:504-364-8968
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA17219104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600720410Medicaid