Provider Demographics
NPI:1780345884
Name:HALPHEN-WIMBERLY, LAUREL JADE (MED, MS, LPC)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:JADE
Last Name:HALPHEN-WIMBERLY
Suffix:
Gender:F
Credentials:MED, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 GRAND POINT RD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3323
Mailing Address - Country:US
Mailing Address - Phone:337-935-2310
Mailing Address - Fax:
Practice Address - Street 1:2309 GRAND POINT RD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3323
Practice Address - Country:US
Practice Address - Phone:337-935-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health