Provider Demographics
NPI:1700189966
Name:GUSMAN, RENEE BERTRAND (LPC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:BERTRAND
Last Name:GUSMAN
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 1:7821 MAPLE ST
Mailing Address - Street 2:#2
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-3960
Mailing Address - Country:US
Mailing Address - Phone:504-813-0951
Mailing Address - Fax:
Practice Address - Street 1:7821 MAPLE STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-813-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4196101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor