Provider Demographics
NPI:1912284332
Name:FELDMAN, MICHAEL ROY (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROY
Last Name:FELDMAN
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 1:12097 OLD HAMMOND HWY STE I3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8679
Mailing Address - Country:US
Mailing Address - Phone:225-412-0130
Mailing Address - Fax:225-412-0140
Practice Address - Street 1:12097 OLD HAMMOND HWY STE I3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8679
Practice Address - Country:US
Practice Address - Phone:225-412-0130
Practice Address - Fax:225-412-0140
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600722912Medicaid