Provider Information for 1538520796
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JASON C FANGUY, LPC
Sex: Male
NPI: 1538520796
Last Updated: 2023-10-03
Certification Date: 2023-10-03
Certification Date: 2023-10-03
Details
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NPI | 1538520796 | ||||||||||||
Enumeration Date | 2016-03-16 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 3398 BROOKWOOD DR HOUMA, LA 70360-7297 United States Phone: 985-856-2990 | Fax: | ||||||||||||
Primary Practice Address | 235 CIVIC CENTER BLVD HOUMA, LA 70360-5937 United States Phone: 985-333-2020 | Fax: | ||||||||||||
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