Individual
MELLISA LAU BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2829 4TH AVE, LAKE CHARLES, LA 70601-7887
(337) 477-7091
(337) 474-4552
Mailing address
2829 4TH AVE, LAKE CHARLES, LA 70601-7887
(337) 477-7091
(337) 474-4552
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6369
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063569648
GROUP NPI
—
05
—
1551228
—
LA
Enumeration date
06/14/2017
Last updated
07/21/2022
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