Provider Demographics
NPI:1417604067
Name:THERIOT, ANASTATIA (LPC)
Entity type:Individual
Prefix:
First Name:ANASTATIA
Middle Name:
Last Name:THERIOT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11161 CAMBRE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6336
Mailing Address - Country:US
Mailing Address - Phone:985-686-0268
Mailing Address - Fax:985-686-0268
Practice Address - Street 1:11161 CAMBRE OAKS DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6336
Practice Address - Country:US
Practice Address - Phone:985-686-0268
Practice Address - Fax:985-686-0268
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9012101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor