MEDICARE: MS. WANDA FAYE VENTRESS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6885	LA
2	101YP2500X	Professional Counselor
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	6885	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6885	OTHER	LA	LA STATE BOARD OF SOCIAL WORKERS

General Provider Information

NPI Number	:	1851801377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WANDA FAYE VENTRESS LCSW

Provider Business Mailing Address
First Line	:	221 VEROT SCHOOL RD APT 437
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-8246
Country	:	US
Telephone Number	:	337-277-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 CHAPPUIS DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-3656
Country	:	US
Telephone Number	:	337-277-6611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	06/23/2023

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