Healthcare Provider Details

I. General information

NPI: 1134872849
Provider Name (Legal Business Name): SUZONNE MCCRORY MORALES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38480 SULLIVAN DR
PEARL RIVER LA
70452-3466
US

IV. Provider business mailing address

38480 SULLIVAN DR
PEARL RIVER LA
70452-3466
US

V. Phone/Fax

Practice location:
  • Phone: 985-863-3141
  • Fax:
Mailing address:
  • Phone: 985-863-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6849
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number6849
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: