Healthcare Provider Details

I. General information

NPI: 1699583351
Provider Name (Legal Business Name): ANGELE MARY THIBODAUX LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PAUL MAILLARD RD STE M1900
LULING LA
70070-4349
US

IV. Provider business mailing address

1057 PAUL MAILLARD RD STE M1900
LULING LA
70070-4349
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-3633
  • Fax: 985-785-3632
Mailing address:
  • Phone: 985-785-3633
  • Fax: 985-785-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8653
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: