Healthcare Provider Details

I. General information

NPI: 1629533542
Provider Name (Legal Business Name): TIKELA NAWANA MANSFIELD MHP/CAS MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIKELA MANSFIELD MSW,CSW,CIT

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W JEFFERSON AVE
BASTROP LA
71220-4543
US

IV. Provider business mailing address

158 PARKER ST
BASTROP LA
71220-3622
US

V. Phone/Fax

Practice location:
  • Phone: 318-239-3890
  • Fax: 318-239-3891
Mailing address:
  • Phone: 318-614-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15899
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number15899
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC-5186
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: