MEDICARE: HORTENSE AMBROSE LPC

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	101YP2500X	Professional Counselor	4800	LA

General Provider Information

NPI Number	:	1710353032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HORTENSE AMBROSE LPC

Provider Business Mailing Address
First Line	:	1296 MAGNOLIA HEIGHTS ST
Second Line	:
City	:	VACHERIE
State	:	LA
Zip	:	70090-5506
Country	:	US
Telephone Number	:	225-624-9703
Fax Number	:

Provider Business Practice Location Address
First Line	:	1296 MAGNOLIA HEIGHTS ST
Second Line	:
City	:	VACHERIE
State	:	LA
Zip	:	70090-5506
Country	:	US
Telephone Number	:	225-624-9703
Fax Number	:

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

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	08/20/2015

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