Basic Information
| Provider Information | |||||||||
| NPI: | 1104552280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAPE | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5011 | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703025011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858602847 | ||||||||
| FaxNumber: | 9858688547 | ||||||||
| Practice Location | |||||||||
| Address1: | 8326 MAIN ST BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703634871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858682620 | ||||||||
| FaxNumber: | 9858688547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2022 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3737 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.