Provider Demographics
NPI:1699146522
Name:WANGERIN LEMOINE, MORGAN LYNNE (MA,LPC-S, C-DBT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LYNNE
Last Name:WANGERIN LEMOINE
Suffix:
Gender:F
Credentials:MA,LPC-S, C-DBT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:LYNNE
Other - Last Name:WANGERIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, NCC, LPC-S
Mailing Address - Street 1:1048 CLAIRE DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-1363
Mailing Address - Country:US
Mailing Address - Phone:504-317-1038
Mailing Address - Fax:
Practice Address - Street 1:1500 LAFAYETTE ST STE 156
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5778
Practice Address - Country:US
Practice Address - Phone:504-608-4769
Practice Address - Fax:504-336-3418
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
13852207OtherCAQH
LA3565277Medicaid