Provider Demographics
NPI:1548821861
Name:GAUTHIER, MARY (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 HIGHWAY 165 S
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-3500
Mailing Address - Country:US
Mailing Address - Phone:318-335-3501
Mailing Address - Fax:
Practice Address - Street 1:1884 HIGHWAY 165 S
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3500
Practice Address - Country:US
Practice Address - Phone:318-335-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional