MEDICARE: DR. BRIDGET VACHA PH.D., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	4664	LA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	4664	LA
3	101YM0800X	Mental Health Counselor	4664	LA
4	101YP2500X	Professional Counselor	4664	LA

General Provider Information

NPI Number	:	1043611791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIDGET VACHA PH.D., LPC

Provider Business Mailing Address
First Line	:	406 BROCKENBRAUGH CT
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-3324
Country	:	US
Telephone Number	:	504-952-2079
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 METAIRIE RD # 8258
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-4034
Country	:	US
Telephone Number	:	504-952-2079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	03/01/2022

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