Individual
IAN MATTHEW DERMODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
252 HECTOR AVE STE A, GRETNA, LA 70056-2548
(504) 435-1444
(504) 372-2775
Mailing address
252 HECTOR AVE STE A, GRETNA, LA 70056-2548
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6759
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-2459201
—
LA
Enumeration date
04/04/2019
Last updated
04/04/2019
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