MEDICARE: WILFRED ALLRIDGE

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

General Provider Information

NPI Number	:	1669906194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILFRED ALLRIDGE

Provider Business Mailing Address
First Line	:	6522 W MAIN ST
Second Line	:
City	:	HOUMA
State	:	LA
Zip	:	70360-2267
Country	:	US
Telephone Number	:	225-478-9533
Fax Number	:	225-478-9534

Provider Business Practice Location Address
First Line	:	6522 W MAIN ST
Second Line	:
City	:	HOUMA
State	:	LA
Zip	:	70360-2267
Country	:	US
Telephone Number	:	225-478-9533
Fax Number	:	225-478-9534

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

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/11/2017

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Directions to “ WILFRED ALLRIDGE ” Practice Location

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