Basic Information
| Provider Information | |||||||||
| NPI: | 1801259445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METHVIN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | PERERO | ||||||||
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| Credential: | LPC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1418 TIGER DR | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703014337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854494055 | ||||||||
| FaxNumber: | 9854494178 | ||||||||
| Practice Location | |||||||||
| Address1: | 1418 TIGER DR | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703014337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854494055 | ||||||||
| FaxNumber: | 9854494178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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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 | 101YP2500X | 3923 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.