Individual
BONNY ANN MAISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC,
Contact information
Practice address
13513 RIVER RD, LULING, LA 70070-4259
(504) 912-0895
(985) 308-1053
Mailing address
130 COTTAGE DR, LULING, LA 70070-3200
(504) 912-0895
(985) 308-1053
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2812
LA
101YS0200X
School Counselor
79507
LA
Other
Enumeration date
03/09/2011
Last updated
04/24/2012
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