Provider Demographics
NPI:1396307377
Name:BILLIOT, MARY LIBBY (CPSS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LIBBY
Last Name:BILLIOT
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 W AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3336
Mailing Address - Country:US
Mailing Address - Phone:985-652-8444
Mailing Address - Fax:985-652-2450
Practice Address - Street 1:1809 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3336
Practice Address - Country:US
Practice Address - Phone:985-652-8444
Practice Address - Fax:985-652-2450
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1750715892Medicaid