Healthcare Provider Details

I. General information

NPI: 1376383638
Provider Name (Legal Business Name): ALDO ALEJANDRO LLAMAS PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 COLONY STATION ST
THIBODAUX LA
70301-1100
US

IV. Provider business mailing address

157 COLONY STATION ST
THIBODAUX LA
70301-1100
US

V. Phone/Fax

Practice location:
  • Phone: 985-709-7798
  • Fax:
Mailing address:
  • Phone: 985-709-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10027
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: