Healthcare Provider Details

I. General information

NPI: 1669537726
Provider Name (Legal Business Name): MICHELLE TRENTON GODEAUX M.,S.,LPC-S,LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MICHELLE TRENTON

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/29/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 STATE STATE
LAKE CHARLES LA
70605
US

IV. Provider business mailing address

PO BOX 2331
SULPHUR LA
70664-2331
US

V. Phone/Fax

Practice location:
  • Phone: 337-915-0900
  • Fax: 337-915-0910
Mailing address:
  • Phone: 337-915-0900
  • Fax: 337-915-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1947
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number287
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1947
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: