Individual
MERRIL THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 W SAINT MARY BLVD STE 210, LAFAYETTE, LA 70506-4699
(337) 233-1114
Mailing address
PO BOX 53388, LAFAYETTE, LA 70505-3388
(337) 233-1114
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2
STATE - LICENSED ADDICTION COUNSELOR
LA
Enumeration date
06/06/2019
Last updated
06/06/2019
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