MEDICARE: MRS. CHRISTINA SPEYRER THIBODEAUX L.P.C., L.M.F.T.

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	0701006026	VA
2	101YM0800X	Mental Health Counselor	P1611170	AR
3	101YM0800X	Mental Health Counselor	4540	LA
4	106H00000X	Marriage & Family Therapist	1150	LA

General Provider Information

NPI Number	:	1922497734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA SPEYRER THIBODEAUX L.P.C., L.M.F.T.

Provider Business Mailing Address
First Line	:	110 SHERIDAN DR.
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506
Country	:	US
Telephone Number	:	337-849-0019
Fax Number	:	479-567-5661

Provider Business Practice Location Address
First Line	:	1405 W PINHOOK RD STE 108A
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3100
Country	:	US
Telephone Number	:	337-849-0019
Fax Number	:	337-234-4038

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

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	08/12/2024

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