Provider Demographics
NPI:1104488956
Name:BERGEAUX, SHELBIE LEE (MA)
Entity type:Individual
Prefix:MRS
First Name:SHELBIE
Middle Name:LEE
Last Name:BERGEAUX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5126
Mailing Address - Country:US
Mailing Address - Phone:337-466-3530
Mailing Address - Fax:337-466-7089
Practice Address - Street 1:3320 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5126
Practice Address - Country:US
Practice Address - Phone:337-466-3530
Practice Address - Fax:337-466-7089
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty