Provider Demographics
NPI:1194570093
Name:LETELIER, DANIELLA
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:LETELIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9677 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-7205
Mailing Address - Country:US
Mailing Address - Phone:225-271-3210
Mailing Address - Fax:
Practice Address - Street 1:9677 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7205
Practice Address - Country:US
Practice Address - Phone:225-271-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional