Provider Demographics
NPI:1548650534
Name:PAUL, NICOLETTE (MS,CI)
Entity type:Individual
Prefix:MRS
First Name:NICOLETTE
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:MS,CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 DRUSILLA LN APT 127
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1480
Mailing Address - Country:US
Mailing Address - Phone:337-292-7138
Mailing Address - Fax:
Practice Address - Street 1:28315 S FROST RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754-2612
Practice Address - Country:US
Practice Address - Phone:225-283-1356
Practice Address - Fax:225-683-1310
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5835101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health