Active NPI
Kerry Thibodeaux, LPC
- Professional Counselor
- Lafayette, LA
National Provider Identifier
1235697384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3491
- Practice address
- 700 Saint Landry St
Lafayette, LA 70506-4630 - Phone
- (337) 210-5145
- NPI assigned
- Mar 7, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 | 3491 | LA | Primary |
Addresses
Primary practice location
700 Saint Landry St
Lafayette, LA 70506-4630
Mailing address
516 E Pinhook Rd
Lafayette, LA 70501-8610
Phone (337) 521-7580
Other practice location 1
805 S Union St
Opelousas, LA 70570-6029
Phone (337) 678-4004
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 |
|---|---|---|---|
| 3491 | LA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Truthful Rehabilitation Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Opelousas, LA
- NPI 1932588506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551916800000",
"number": "1235697384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "516 E PINHOOK RD",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705018610",
"telephone_number": "337-521-7580",
"fax_number": "337-521-7581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 SAINT LANDRY ST",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705064630",
"telephone_number": "337-210-5145"
}
],
"practiceLocations": [
{
"address_1": "805 S Union St",
"address_purpose": "LOCATION",
"city": "Opelousas",
"state": "LA",
"postal_code": "705706029",
"country_code": "US",
"telephone_number": "337-678-4004",
"fax_number": "337-678-3777",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THIBODEAUX",
"first_name": "KERRY",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-07",
"last_updated": "2019-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "LA",
"license": "3491",
"primary": true
}
],
"identifiers": [],
"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 Mar 7, 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.