Grace De Souza
Individual provider Active NPI Marriage & Family Therapist · Covington, LA
NPI 1679936371 · NPPES record last updated Mar 3, 2024
Key facts
- NPI
- 1679936371
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 1388 (LA)
- Practice address
- 70380 Highway 21 Ste 2266
Covington, LA 70433-8128 - Phone
- (985) 260-2266
- NPI assigned
- Mar 30, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1388 | LA | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1388 | LA | Yes |
| Marriage & Family Therapist | 106H00000X |
Addresses
Primary practice location
70380 Highway 21 Ste 2266
Covington, LA 70433-8128
Mailing address
70380 Highway 21 Ste 2-266
Covington, LA 70433-8128
Other practice location 1
201 Rue Beauregard Ste 202
Lafayette, LA 70508-3251
Phone (415) 403-2156
Other names
- Grace Jackson
Other providers in Covington, LA
- Adriene Dawkins
- Jennifer C Day
- Krista Dooley Dazzo
- De Los Reyes Chiropractic
- Frank Pascualin De Paula
- Farrah Dean
- Shawn Dearie
- Edward Jackson Dease III
- Janet Elizabeth Debarbieris
- Sarah Guillot Deckwa
All providers in Covington, LA · Marriage & Family Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.