Healthcare Provider Details

I. General information

NPI: 1831005503
Provider Name (Legal Business Name): BAILEE FONCREE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42122 N CITY PARK DR
SORRENTO LA
70778-3442
US

IV. Provider business mailing address

42122 N CITY PARK DR
SORRENTO LA
70778-3442
US

V. Phone/Fax

Practice location:
  • Phone: 225-916-6749
  • Fax:
Mailing address:
  • Phone: 225-916-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC11103
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: