Healthcare Provider Details

I. General information

NPI: 1891911822
Provider Name (Legal Business Name): ANGELLE M ESCOUSSE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 AVENUE E
BOGALUSA LA
70427-3628
US

IV. Provider business mailing address

602 AVENUE E
BOGALUSA LA
70427-3628
US

V. Phone/Fax

Practice location:
  • Phone: 985-276-0349
  • Fax: 504-278-4007
Mailing address:
  • Phone: 985-276-0349
  • Fax: 504-278-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC8307
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4140
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: