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General NPI Number Information
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NPI Number | 1841985173
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Entity Type | Organization
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Legal Business Name | MMT THERAPY AND WELLNESS
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 814 FORTUNE RD STE 108
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-5542
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Country | US
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Telephone | 337-513-0822
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Fax | 337-202-2376
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Provider Business Mailing Address
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Address Line | 8448 STEVE RD
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City | KAPLAN
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State | LA
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Zip | 70548-6437
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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 | LCSW
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Name | MICHELE THIBODEAUX
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Credential |
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Telephone | 337-501-8697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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