Healthcare Provider Details

I. General information

NPI: 1922497734
Provider Name (Legal Business Name): CHRISTINA SPEYRER THIBODEAUX L.P.C., L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA SPEYRER LPC-INTERN, LMFT-INT

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W PINHOOK RD STE 108A
LAFAYETTE LA
70503-3100
US

IV. Provider business mailing address

110 SHERIDAN DR.
LAFAYETTE LA
70506
US

V. Phone/Fax

Practice location:
  • Phone: 337-849-0019
  • Fax: 337-234-4038
Mailing address:
  • Phone: 337-849-0019
  • Fax: 479-567-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701006026
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1611170
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4540
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1150
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: