Basic Information
| Provider Information | |||||||||
| NPI: | 1114392693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMEAUX | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A, LPC, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 ASMA BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705083858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374129030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1325 WRIGHT AVE | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705262226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375145181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2015 | ||||||||
| LastUpdateDate: | 02/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 5947 | LA | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 1247 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | 5947 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1114392693 | 05 | LA | MEDICAID |