Provider Demographics
NPI:1750846911
Name:THIBODEAUX, BRETT MICHAEL (MS, PLPC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:MICHAEL
Last Name:THIBODEAUX
Suffix:
Gender:M
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 W PINHOOK RD STE 306
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3735
Mailing Address - Country:US
Mailing Address - Phone:337-256-9282
Mailing Address - Fax:
Practice Address - Street 1:1602 W PINHOOK RD STE 306
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3735
Practice Address - Country:US
Practice Address - Phone:337-256-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7687101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE