Basic Information
Provider Information | |||||||||
NPI: | 1548682057 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HEBERT | ||||||||
FirstName: | MICHELLE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3522 OLE MISS DR | ||||||||
Address2: |   | ||||||||
City: | KENNER | ||||||||
State: | LA | ||||||||
PostalCode: | 700652512 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5044013424 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 330 N JEFFERSON DAVIS PKWY | ||||||||
Address2: |   | ||||||||
City: | NEW ORLEANS | ||||||||
State: | LA | ||||||||
PostalCode: | 701195312 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5049486880 | ||||||||
FaxNumber: | 5042784007 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/17/2014 | ||||||||
LastUpdateDate: | 08/04/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6208 | LA | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
ID | Type | State | Issuer | Description | 6208 | 01 | LA | STATE OF LOUISIANA LICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS | OTHER |