MEDICARE: MR. DARYL HEBERT LPC,LAC,CRC,CCGC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	737	LA
2	101YM0800X	Mental Health Counselor	4224	LA

General Provider Information

NPI Number	:	1811201726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARYL HEBERT LPC,LAC,CRC,CCGC

Provider Business Mailing Address
First Line	:	PO BOX 513
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70707-0513
Country	:	US
Telephone Number	:	225-921-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	14635 S HARRELLS FERRY RD
Second Line	:	SUITE 6C
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2959
Country	:	US
Telephone Number	:	225-921-8855
Fax Number	:

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

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/27/2010

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