Healthcare Provider Details

I. General information

NPI: 1891929105
Provider Name (Legal Business Name): MARGO HASHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NATHALIE ST
LAFAYETTE LA
70506-3540
US

IV. Provider business mailing address

110 NATHALIE ST
LAFAYETTE LA
70506-3540
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-5656
  • Fax: 337-234-5670
Mailing address:
  • Phone: 337-234-5656
  • Fax: 337-234-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3128
License Number StateLA

VIII. Authorized Official

Name: MARGOT HASHA
Title or Position: LCSW
Credential: LCSW
Phone: 337-234-5656