Provider Demographics
NPI:1174810931
Name:PELLICHINO, MONA M (MED, LPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:MONA
Middle Name:M
Last Name:PELLICHINO
Suffix:
Gender:F
Credentials:MED, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17104 E LITTLE ITALY RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6306
Mailing Address - Country:US
Mailing Address - Phone:985-542-1011
Mailing Address - Fax:985-542-1011
Practice Address - Street 1:1216 S MORRISON BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5702
Practice Address - Country:US
Practice Address - Phone:985-320-2870
Practice Address - Fax:985-340-5025
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2596101Y00000X, 101YP2500X
LA746106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist