Active NPI
Merril Thibodeaux
- Professional Counselor
- Lafayette, LA
National Provider Identifier
1164081832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2
- Practice address
- 501 W Saint Mary Blvd Ste 210
Lafayette, LA 70506-4699 - Phone
- (337) 233-1114
- NPI assigned
- Jun 6, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2 | LA | Primary |
Addresses
Primary practice location
501 W Saint Mary Blvd Ste 210
Lafayette, LA 70506-4699
Mailing address
PO Box 53388
Lafayette, LA 70505-3388
Phone (337) 233-1114
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2 | Other | LA | STATE - LICENSED ADDICTION COUNSELOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2 | LA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Wellness Center, LLC | Past | Accepting new patients | |
| Lake Professionals LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Physician
- Lafayette, LA
- NPI 1497313670
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Boutte, LA
- NPI 1740824507
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559779200000",
"number": "1164081832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 53388",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705053388",
"telephone_number": "337-233-1114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 W SAINT MARY BLVD STE 210",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705064699",
"telephone_number": "337-233-1114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIBODEAUX",
"first_name": "MERRIL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-06",
"last_updated": "2019-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "LA",
"license": "2",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE - LICENSED ADDICTION COUNSELOR",
"identifier": "2",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.