Basic Information
| Provider Information | |||||||||
| NPI: | 1821355017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEBLANC | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8245 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708086819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858693999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1112 E ASCENSION COMPLEX BLVD | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707374265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256215775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2012 | ||||||||
| LastUpdateDate: | 04/12/2012 | ||||||||
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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 | 101YM0800X | NCC# 291801 CI#5036 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.