Healthcare Provider Details

I. General information

NPI: 1356865125
Provider Name (Legal Business Name): TESSIA GUILLORY REQUENA-OZENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W PINHOOK RD STE 107H
LAFAYETTE LA
70503-3100
US

IV. Provider business mailing address

PO BOX 128
YOUNGSVILLE LA
70592-0128
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0770
  • Fax:
Mailing address:
  • Phone: 337-550-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8147
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: