Healthcare Provider Details

I. General information

NPI: 1649105016
Provider Name (Legal Business Name): JUSTIN GUY DSW, LCSW-BACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 COMMERCE CIR APT 8304
BATON ROUGE LA
70809-1893
US

IV. Provider business mailing address

6929 COMMERCE CIR APT 8304
BATON ROUGE LA
70809-1893
US

V. Phone/Fax

Practice location:
  • Phone: 225-308-1530
  • Fax:
Mailing address:
  • Phone: 225-308-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13272
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: