Provider Demographics
NPI:1811358708
Name:BEGAULT, TATIANA SOFIA (BS,)
Entity type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:SOFIA
Last Name:BEGAULT
Suffix:
Gender:F
Credentials:BS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 S RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1022
Mailing Address - Country:US
Mailing Address - Phone:504-275-7489
Mailing Address - Fax:
Practice Address - Street 1:1385 S RIDGE DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-1022
Practice Address - Country:US
Practice Address - Phone:504-275-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2997376101YM0800X, 390200000X
LA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker