Individual
JASON C FANGUY, LPC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
235 CIVIC CENTER BLVD, HOUMA, LA 70360-5937
(985) 333-2020
Mailing address
3398 BROOKWOOD DR, HOUMA, LA 70360-7297
(985) 856-2990
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
8752
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8752
LICENSED PROFESSIONAL COUNSELOR LICENSE #8752
LA
Enumeration date
03/16/2016
Last updated
10/03/2023
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