Provider Demographics
NPI:1912462169
Name:ANATOLE, LEATHA KAY (LPC)
Entity Type:Individual
Prefix:
First Name:LEATHA
Middle Name:KAY
Last Name:ANATOLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6729
Mailing Address - Country:US
Mailing Address - Phone:337-345-6130
Mailing Address - Fax:
Practice Address - Street 1:401 W VERMILION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6729
Practice Address - Country:US
Practice Address - Phone:337-345-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty