Individual
MRS. MARY F SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-S, LMFT
Contact information
Practice address
100 N 13TH ST, PONCHATOULA, LA 70454
(985) 517-7034
Mailing address
100 N 13TH ST, PONCHATOULA, LA 70454
(985) 517-7034
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2724
LA
106H00000X
Marriage & Family Therapist
851
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972911345
ORGANIZATIONAL NPI
—
Enumeration date
11/09/2017
Last updated
04/14/2020
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