Provider Demographics
NPI:1386282952
Name:WENDELL, MARK (LPC, MA, MAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WENDELL
Suffix:
Gender:M
Credentials:LPC, MA, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13838 BOYTER LN
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-9788
Mailing Address - Country:US
Mailing Address - Phone:318-519-9034
Mailing Address - Fax:318-375-2643
Practice Address - Street 1:13838 BOYTER LN
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-9788
Practice Address - Country:US
Practice Address - Phone:318-519-9034
Practice Address - Fax:318-375-2643
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-14
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4798OtherSTATE BOARD