MEDICARE: CONNIE H. LEBLANC M.S. LPC LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	242	LA
2	101YP2500X	Professional Counselor	2281	LA

General Provider Information

NPI Number	:	1174562995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE H. LEBLANC M.S. LPC LMFT

Provider Business Mailing Address
First Line	:	1304 BERTRAND DRIVE
Second Line	:	SUITE D-4
City	:	LAFAYETTE
State	:	LA
Zip	:	70506
Country	:	US
Telephone Number	:	337-849-4531
Fax Number	:	337-237-2226

Provider Business Practice Location Address
First Line	:	315 S COLLEGE RD
Second Line	:	SUITE 277
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3212
Country	:	US
Telephone Number	:	337-237-4229
Fax Number	:	337-289-1416

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/10/2024

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