Healthcare Provider Details

I. General information

NPI: 1902976681
Provider Name (Legal Business Name): WILLIAM GLEN MAGEE LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 W AIRLINE HWY
LA PLACE LA
70068-3336
US

IV. Provider business mailing address

1809 W AIRLINE HWY
LA PLACE LA
70068-3336
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-8444
  • Fax: 985-652-2450
Mailing address:
  • Phone: 985-652-8444
  • Fax: 985-652-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2403
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: