Healthcare Provider Details

I. General information

NPI: 1740297043
Provider Name (Legal Business Name): DANIEL CRAIG THIBODEAUX LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 WESTANK EXPRESSWAY
MARRERO LA
70072
US

IV. Provider business mailing address

3300 WEST ESPLANADE AVE
METAIRIE LA
70002
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-8708
  • Fax: 504-838-5714
Mailing address:
  • Phone: 504-838-5716
  • Fax: 504-838-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2603
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: