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General NPI Number Information
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NPI Number | 1023664372
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Entity Type | Individual
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Provider Name | MICHAEL GENE WALDRIP
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Gender | Male
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 1799 STUMPF BLVD. BUILDING 3, SUITE 2
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City | TERRYTOWN
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State | LA
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Zip | 70056-7005
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Country | US
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Telephone | 504-255-4205
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Fax |
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Provider Business Mailing Address
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Address Line | 3715 LAKE VILLA DR
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City | METAIRIE
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State | LA
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Zip | 70002-4331
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Country | US
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Telephone | 504-255-4205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5590
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License Number State | LA
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