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General NPI Number Information
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NPI Number | 1346483385
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Entity Type | Individual
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Provider Name | WALTER BREAUX III LPC-S, PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/22/2019
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Provider Practice Location Address
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Address Line | 308 PELLERIN DR
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City | KENNER
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State | LA
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Zip | 70065-2553
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Country | US
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Telephone | 504-237-1264
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Fax |
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Provider Business Mailing Address
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Address Line | 308 PELLERIN DR
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City | KENNER
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State | LA
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Zip | 70065-2553
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Country | US
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Telephone | 504-237-1264
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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 | 005553
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License Number State | GA
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