Provider Demographics
NPI:1588899132
Name:COULLIETTE, TONYA (LAC, LPC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:COULLIETTE
Suffix:
Gender:F
Credentials:LAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N RENDON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3902
Mailing Address - Country:US
Mailing Address - Phone:504-782-0946
Mailing Address - Fax:
Practice Address - Street 1:330 N JEFFERSON DAVIS PKWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5312
Practice Address - Country:US
Practice Address - Phone:504-782-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1234101YA0400X
LA3877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)