Healthcare Provider Details

I. General information

NPI: 1093144164
Provider Name (Legal Business Name): IDA ANDING CHAUVIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BURGESSVILLE RD
RUSTON LA
71270-5154
US

IV. Provider business mailing address

243 HIGHWAY 3005
RUSTON LA
71270-1074
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-7223
  • Fax: 318-415-1004
Mailing address:
  • Phone: 318-278-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2401
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2401
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2401
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT278
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: