Healthcare Provider Details

I. General information

NPI: 1669983623
Provider Name (Legal Business Name): YUDILAINE ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 GENERAL DE GAULLE DR STE 206
NEW ORLEANS LA
70131-6309
US

IV. Provider business mailing address

3808 TULANE DR
KENNER LA
70065-1626
US

V. Phone/Fax

Practice location:
  • Phone: 504-758-3114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007994614
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: