Healthcare Provider Details

I. General information

NPI: 1568119311
Provider Name (Legal Business Name): CARRIE MICHELLE CHANDLER PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE MICHELLE THIBODEAUX

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 UNIVERSITY DR.
LAKE CHARLES LA
70605-6141
US

IV. Provider business mailing address

815 UNIVERSITY DR.
LAKE CHARLES LA
70605-6141
US

V. Phone/Fax

Practice location:
  • Phone: 337-499-2399
  • Fax: 337-232-0044
Mailing address:
  • Phone: 337-499-2399
  • Fax: 337-232-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10824
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: