Provider Demographics
NPI:1144722257
Name:MATHERNE, MICHAELA RAE (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:RAE
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:158 REGAL ROW
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6097
Mailing Address - Country:US
Mailing Address - Phone:985-857-3748
Mailing Address - Fax:985-857-3782
Practice Address - Street 1:157 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2761
Practice Address - Country:US
Practice Address - Phone:985-537-6823
Practice Address - Fax:985-537-5519
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional