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General NPI Number Information
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NPI Number | 1407380934
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Entity Type | Individual
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Provider Name | MICHAEL DISALVO LPC
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Gender | Male
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 142 RUE MARGUERITE APT A
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City | THIBODAUX
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State | LA
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Zip | 70301-6746
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Country | US
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Telephone | 985-625-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 5342 W MAIN ST
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City | HOUMA
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State | LA
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Zip | 70360-1254
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Country | US
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Telephone | 985-804-1107
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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 | 5865
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License Number State | LA
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