Healthcare Provider Details

I. General information

NPI: 1902679582
Provider Name (Legal Business Name): PAIGE PELLEGRIN MA, LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAIGE MCELROY

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MENARD DR
BOURG LA
70343-3631
US

IV. Provider business mailing address

103 MENARD DR
BOURG LA
70343-3631
US

V. Phone/Fax

Practice location:
  • Phone: 985-804-2112
  • Fax:
Mailing address:
  • Phone: 985-804-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6200
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6200
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6200
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: