Provider Demographics
NPI:1912591710
Name:BUDO, MAREIKE TENBERGE (LPC ESMHL CTRI RM)
Entity Type:Individual
Prefix:
First Name:MAREIKE
Middle Name:TENBERGE
Last Name:BUDO
Suffix:
Gender:F
Credentials:LPC ESMHL CTRI RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 S ROCHEBLAVE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4549
Mailing Address - Country:US
Mailing Address - Phone:504-715-8251
Mailing Address - Fax:
Practice Address - Street 1:4300 S I 10 SERVICE RD W STE 117
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7427
Practice Address - Country:US
Practice Address - Phone:504-841-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1881909042Medicaid