Provider Demographics
NPI:1235534512
Name:DANTIN, BEAU S (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:BEAU
Middle Name:S
Last Name:DANTIN
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 WEYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1481
Mailing Address - Country:US
Mailing Address - Phone:225-361-0899
Mailing Address - Fax:337-855-1829
Practice Address - Street 1:2325 WEYMOUTH DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1481
Practice Address - Country:US
Practice Address - Phone:225-361-0899
Practice Address - Fax:337-855-1829
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4770101YA0400X, 103TA0400X, 103TF0000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000000Medicaid