Healthcare Provider Details

I. General information

NPI: 1104745991
Provider Name (Legal Business Name): ALLY DEGRUISE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8416 CUMBERLAND PL
BATON ROUGE LA
70806-6543
US

IV. Provider business mailing address

8416 CUMBERLAND PL
BATON ROUGE LA
70806-6543
US

V. Phone/Fax

Practice location:
  • Phone: 225-408-6051
  • Fax:
Mailing address:
  • Phone: 225-408-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number19932
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: