Provider Demographics
NPI:1538268149
Name:IFLAND, MARK DAVID (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:IFLAND
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-1022
Mailing Address - Country:US
Mailing Address - Phone:337-463-4900
Mailing Address - Fax:337-463-4908
Practice Address - Street 1:701 S ROYAL ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4949
Practice Address - Country:US
Practice Address - Phone:337-463-4900
Practice Address - Fax:337-463-4908
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA289106H00000X
LA1964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist