Healthcare Provider Details

I. General information

NPI: 1255490579
Provider Name (Legal Business Name): DONNA LEBLANC AUCOIN PH.D., MP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 KALISTE SALOOM RD
LAFAYETTE LA
70508-7449
US

IV. Provider business mailing address

3312 KALISTE SALOOM RD
LAFAYETTE LA
70508-7449
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-0788
  • Fax: 337-237-0785
Mailing address:
  • Phone: 337-237-0788
  • Fax: 337-237-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMP.000839
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number839
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number839
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: