Provider Demographics
NPI:1104162239
Name:MICHOT, JAIME R (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:R
Last Name:MICHOT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CHAPLIN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-2101
Mailing Address - Country:US
Mailing Address - Phone:337-501-7169
Mailing Address - Fax:337-521-7088
Practice Address - Street 1:2645 S FIELDSPAN RD
Practice Address - Street 2:
Practice Address - City:DUSON
Practice Address - State:LA
Practice Address - Zip Code:70529-4201
Practice Address - Country:US
Practice Address - Phone:337-501-7169
Practice Address - Fax:337-521-7891
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41991041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool