Provider Demographics
NPI:1053118067
Name:WESLEY, UMBRANESHA
Entity type:Individual
Prefix:
First Name:UMBRANESHA
Middle Name:
Last Name:WESLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 RUE SAINT HONORE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8211
Mailing Address - Country:US
Mailing Address - Phone:504-273-8391
Mailing Address - Fax:
Practice Address - Street 1:2409 RUE SAINT HONORE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-8211
Practice Address - Country:US
Practice Address - Phone:504-273-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician