Provider Demographics
NPI:1386171999
Name:SAUSSAYE, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SAUSSAYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HOLIDAY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5088
Mailing Address - Country:US
Mailing Address - Phone:504-320-6417
Mailing Address - Fax:
Practice Address - Street 1:201 HOLIDAY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5088
Practice Address - Country:US
Practice Address - Phone:504-320-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3738101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)