Provider Demographics
NPI:1679863005
Name:MATHEWS, DEANNA (MED, LPC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-2737
Mailing Address - Country:US
Mailing Address - Phone:985-969-7156
Mailing Address - Fax:985-370-2022
Practice Address - Street 1:109 S CATE ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4299
Practice Address - Country:US
Practice Address - Phone:985-969-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health