Healthcare Provider Details

I. General information

NPI: 1710615927
Provider Name (Legal Business Name): WHITNEY MEDIATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 VALHI LAGOON XING
HOUMA LA
70360-3208
US

IV. Provider business mailing address

144 VALHI LAGOON XING
HOUMA LA
70360-3208
US

V. Phone/Fax

Practice location:
  • Phone: 985-709-0056
  • Fax: 985-262-4625
Mailing address:
  • Phone: 985-870-2291
  • Fax: 985-236-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: HEATHER NAQUIN
Title or Position: AMINISTRATOR
Credential:
Phone: 985-709-0056