Provider Demographics
NPI:1316132160
Name:ANDERSON, LAURIE O (LPC NCC)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:O
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 BILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448
Mailing Address - Country:US
Mailing Address - Phone:504-491-3402
Mailing Address - Fax:985-674-3406
Practice Address - Street 1:450 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4699
Practice Address - Country:US
Practice Address - Phone:504-491-3402
Practice Address - Fax:985-674-3406
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2714101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional