Healthcare Provider Details

I. General information

NPI: 1558958397
Provider Name (Legal Business Name): VIRGINIA CATHERINE JENSEN PEDEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316B GIROD ST
MANDEVILLE LA
70448-5813
US

IV. Provider business mailing address

25134 HIGHWAY 190
LACOMBE LA
70445-4514
US

V. Phone/Fax

Practice location:
  • Phone: 985-238-3413
  • Fax:
Mailing address:
  • Phone: 985-238-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT1398
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: