=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003614371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONIQUE ELISE LEBLANC-BOWERS PLPC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2025
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5401 JACKSON ST STE B
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71303-2595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-625-7434
-----------------------------------------------------
Fax | 866-238-8404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4436 DELIA LN
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71360-7354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-446-2855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 9893
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------