Healthcare Provider Details

I. General information

NPI: 1154826626
Provider Name (Legal Business Name): LISA RENEE BABINEAUX MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W CONVENT ST
LAFAYETTE LA
70501
US

IV. Provider business mailing address

113 W CONVENT ST
LAFAYETTE LA
70501-6903
US

V. Phone/Fax

Practice location:
  • Phone: 337-680-9540
  • Fax: 337-534-4370
Mailing address:
  • Phone: 337-680-9540
  • Fax: 337-534-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: