Provider Demographics
NPI:1104966696
Name:HEBERT, PATRICK (LCSW #10194)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:HEBERT
Suffix:
Gender:M
Credentials:LCSW #10194
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1476 , 507 PERRY LANE
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-1476
Mailing Address - Country:US
Mailing Address - Phone:337-274-2452
Mailing Address - Fax:337-475-3105
Practice Address - Street 1:3505 5TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2156
Practice Address - Country:US
Practice Address - Phone:337-475-4861
Practice Address - Fax:337-475-3105
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical