MEDICARE: MISS MICHELE RENEE VINCENT LCSW

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	101YM0800X	Mental Health Counselor	4274	LA

General Provider Information

NPI Number	:	1225251986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELE RENEE VINCENT LCSW

Provider Business Mailing Address
First Line	:	805 ALBERTSON PKWY STE A
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-4350
Country	:	US
Telephone Number	:	337-330-4730
Fax Number	:	337-330-4732

Provider Business Practice Location Address
First Line	:	805 ALBERTSON PKWY STE A
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-4350
Country	:	US
Telephone Number	:	337-330-4730
Fax Number	:	337-330-4732

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	10/22/2025

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