Provider Demographics
NPI:1427483692
Name:LEDOUX, SHANTELE H (MED, LPC)
Entity type:Individual
Prefix:
First Name:SHANTELE
Middle Name:H
Last Name:LEDOUX
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MRS
Other - First Name:SHANTELE
Other - Middle Name:M
Other - Last Name:HENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:1494 MONTGOMERY RD LOT 3
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0604
Mailing Address - Country:US
Mailing Address - Phone:337-351-6734
Mailing Address - Fax:
Practice Address - Street 1:117 HEYMANN BLVD STE 10
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2397
Practice Address - Country:US
Practice Address - Phone:337-806-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health