Healthcare Provider Details

I. General information

NPI: 1710458773
Provider Name (Legal Business Name): SCOTT LEBLEU LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W PINHOOK RD STE 100A
LAFAYETTE LA
70508-3745
US

IV. Provider business mailing address

414 LIVE OAK DR.
LAFAYETTE LA
70503
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2180
  • Fax:
Mailing address:
  • Phone: 337-296-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8148
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: