Provider Demographics
NPI:1174877328
Name:TOUSAINT, AUDRA JAVAISE (LPC-S, PHD)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:JAVAISE
Last Name:TOUSAINT
Suffix:
Gender:F
Credentials:LPC-S, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211 S MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3943
Mailing Address - Country:US
Mailing Address - Phone:504-270-1723
Mailing Address - Fax:
Practice Address - Street 1:2601 N HULLEN ST STE 200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5964
Practice Address - Country:US
Practice Address - Phone:504-270-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014720101YP2500X
LA6529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional