Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6349 | LA |
NPI | 1003335001 |
---|---|
Provider Name | Mr. Lucas Alexander Westphal |
First Address | Ponchatoula, LA 70454 |
Second Address | Hammond, LA 70403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 12/09/2017 |