Healthcare Provider Details

I. General information

NPI: 1619004397
Provider Name (Legal Business Name): MELDA-CLAUDE PROFESSIONAL COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W AIRLINE HWY STE D UPPER
LA PLACE LA
70068-3825
US

IV. Provider business mailing address

425 W AIRLINE HWY STE D UPPER
LA PLACE LA
70068-3825
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-2052
  • Fax: 225-869-8049
Mailing address:
  • Phone: 985-652-2052
  • Fax: 225-869-8049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 1963
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 247
License Number StateLA

VIII. Authorized Official

Name: DR. JUDY ANN PETIT
Title or Position: CLINICAL COUNSELOR
Credential: PH.D, LPC, LMFT, NCC
Phone: 985-652-2052