Healthcare Provider Details

I. General information

NPI: 1659787190
Provider Name (Legal Business Name): RICHARD NAQUIN RPH,LPC,LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2014
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 BLAKE CT
THIBODAUX LA
70301-3503
US

IV. Provider business mailing address

519 BLAKE CT
THIBODAUX LA
70301-3503
US

V. Phone/Fax

Practice location:
  • Phone: 504-913-8776
  • Fax:
Mailing address:
  • Phone: 504-913-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2218
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10571
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: