Healthcare Provider Details

I. General information

NPI: 1629338504
Provider Name (Legal Business Name): DEDRA N LOUIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 TULANE AVE STE 305
NEW ORLEANS LA
70119
US

IV. Provider business mailing address

3308 TULANE AVE STE 305
NEW ORLEANS LA
70119-7191
US

V. Phone/Fax

Practice location:
  • Phone: 504-410-5033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4480
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number4480
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4480
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: