Provider Demographics
NPI:1396192993
Name:BLEAKLEY, ADRIENNE LEWIS (MA, LPC)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LEWIS
Last Name:BLEAKLEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:16433 JOE SEVARIO RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5831
Mailing Address - Country:US
Mailing Address - Phone:318-613-6912
Mailing Address - Fax:
Practice Address - Street 1:37539 HIGHWAY 427
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3710
Practice Address - Country:US
Practice Address - Phone:225-244-9110
Practice Address - Fax:504-335-0775
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC6676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional