1275789620 NPI number — BRITTANY LACE PAQUETTE MS, LMHC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275789620 NPI number — BRITTANY LACE PAQUETTE MS, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAQUETTE
Provider First Name:
BRITTANY
Provider Middle Name:
LACE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEGER
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
LACE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275789620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 BAYOU BLVD. SUITE 35B UNIT 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-400-8371
Provider Business Mailing Address Fax Number:
850-626-7171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 BAYOU BLVD.
Provider Second Line Business Practice Location Address:
SUITE 35B UNIT 3
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503-3250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-400-8371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH11770 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 014147100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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