Healthcare Provider Details

I. General information

NPI: 1386532794
Provider Name (Legal Business Name): TIFFANY AVELALLEMANT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 CARROLL ST
MANDEVILLE LA
70448-5126
US

IV. Provider business mailing address

68320 FRIER CT
MANDEVILLE LA
70471-7213
US

V. Phone/Fax

Practice location:
  • Phone: 985-674-5475
  • Fax:
Mailing address:
  • Phone: 985-285-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: