Healthcare Provider Details

I. General information

NPI: 1588847743
Provider Name (Legal Business Name): SHALONDA NICHOLE PROVOST MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18331 HWY 182 WEST
BALDWIN LA
70514
US

IV. Provider business mailing address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

V. Phone/Fax

Practice location:
  • Phone: 337-924-9418
  • Fax: 337-924-9165
Mailing address:
  • Phone: 337-828-2550
  • Fax: 337-355-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5669
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: