Healthcare Provider Details

I. General information

NPI: 1821536806
Provider Name (Legal Business Name): REGINA MAILLOUX JENSEN LPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA GILLESPIE MAILLOUX LAC, LPC, NCC

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MARINERS PLAZA DR STE 408F
MANDEVILLE LA
70448-4797
US

IV. Provider business mailing address

400 MARINERS PLAZA DR STE 408F
MANDEVILLE LA
70448-4797
US

V. Phone/Fax

Practice location:
  • Phone: 958-718-4507
  • Fax: 504-617-7878
Mailing address:
  • Phone: 985-464-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1574
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8517
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1574
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: