Healthcare Provider Details

I. General information

NPI: 1609142249
Provider Name (Legal Business Name): MELODY BENNETT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 C M FAGAN DR STE A3
HAMMOND LA
70403-6056
US

IV. Provider business mailing address

906 C M FAGAN DR STE A3
HAMMOND LA
70403-6056
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-1121
  • Fax: 985-662-5165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2890
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number891
License Number StateLA

VIII. Authorized Official

Name: MRS. MELODY L BENNETT
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC, LMFT
Phone: 985-345-1121