Provider Demographics
NPI:1043039522
Name:DESORMEAUX, CALLIE ELIZABETH (PLPC)
Entity type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:ELIZABETH
Last Name:DESORMEAUX
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 NE EVANGELINE TRWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-2554
Mailing Address - Country:US
Mailing Address - Phone:337-534-8679
Mailing Address - Fax:337-534-0027
Practice Address - Street 1:132 DEMANADE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2508
Practice Address - Country:US
Practice Address - Phone:337-534-8762
Practice Address - Fax:337-534-0027
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health