Provider Demographics
NPI:1184509200
Name:OLUSANYA, MICHAEL OLUSEGUN (PLPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:OLUSEGUN
Last Name:OLUSANYA
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 BELLE CHASSE HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-6733
Mailing Address - Country:US
Mailing Address - Phone:504-788-6801
Mailing Address - Fax:
Practice Address - Street 1:2550 BELLE CHASSE HWY STE 150
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-6733
Practice Address - Country:US
Practice Address - Phone:504-788-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10855101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health