Healthcare Provider Details

I. General information

NPI: 1174562995
Provider Name (Legal Business Name): CONNIE H. LEBLANC M.S. LPC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S COLLEGE RD SUITE 277
LAFAYETTE LA
70503-3212
US

IV. Provider business mailing address

1304 BERTRAND DRIVE SUITE D-4
LAFAYETTE LA
70506
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-4229
  • Fax: 337-289-1416
Mailing address:
  • Phone: 337-849-4531
  • Fax: 337-237-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number242
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2281
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: