Active NPI
Tracie Thibodeaux
- Mental Health Counselor
- Baton Rouge, LA
National Provider Identifier
1568819704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- PLC6670
- Practice address
- 9441 Common St
Suite B
Baton Rouge, LA 70809-1463 - Phone
- (225) 923-3733
- Fax
- (225) 923-3735
- NPI assigned
- May 18, 2016
- Last updated
- May 18, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | PLC6670 | LA | Primary |
Addresses
Primary practice location
9441 Common St
Suite B
Baton Rouge, LA 70809-1463
Mailing address
9441 Common St
Suite B
Baton Rouge, LA 70809-1463
Phone (225) 923-3733
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 600964601 | Medicaid | LA |
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 |
|---|---|---|---|
| PLC6670 | LA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463529600000",
"number": "1568819704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9441 COMMON ST",
"address_2": "SUITE B",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708091463",
"telephone_number": "225-923-3733",
"fax_number": "225-923-3735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9441 COMMON ST",
"address_2": "SUITE B",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708091463",
"telephone_number": "225-923-3733",
"fax_number": "225-923-3735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIBODEAUX",
"first_name": "TRACIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-18",
"last_updated": "2016-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "LA",
"license": "PLC6670",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "600964601",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.