Provider Demographics
NPI:1881112803
Name:LATIOLAIS, CLAYTON DAVID (LPC)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:DAVID
Last Name:LATIOLAIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S AUDUBON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2527
Mailing Address - Country:US
Mailing Address - Phone:337-288-4095
Mailing Address - Fax:337-534-8057
Practice Address - Street 1:121 S AUDUBON BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-288-4095
Practice Address - Fax:337-534-8057
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health