MEDICARE: CANDICE GUILBEAU M.S., LPC, RPT

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	101YM0800X	Mental Health Counselor	6796	LA

General Provider Information

NPI Number	:	1538641253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE GUILBEAU M.S., LPC, RPT

Provider Business Mailing Address
First Line	:	202 COVENTRY ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-6182
Country	:	US
Telephone Number	:	337-315-9683
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 GUILBEAU RD STE 5C
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-6954
Country	:	US
Telephone Number	:	330-967-0506
Fax Number	:

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

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	05/16/2020

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