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General NPI Number Information
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NPI Number | 1568250728
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Entity Type | Individual
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Provider Name | MALLORY LASTRAPES
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 2400 CANAL ST
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City | NEW ORLEANS
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State | LA
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Zip | 70119-6535
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Country | US
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Telephone | 800-935-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 210 PINEHILLS DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-3318
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Country | US
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Telephone |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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