Healthcare Provider Details

I. General information

NPI: 1730521246
Provider Name (Legal Business Name): LUCIEN LAROCHE MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 OYSTER BAY CIR APT. 250
ALTAMONTE SPRINGS FL
32701-8085
US

IV. Provider business mailing address

133 OYSTER BAY CIR APT. 250
ALTAMONTE SPRINGS FL
32701-8085
US

V. Phone/Fax

Practice location:
  • Phone: 321-277-7751
  • Fax:
Mailing address:
  • Phone: 321-277-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: