Healthcare Provider Details

I. General information

NPI: 1467463331
Provider Name (Legal Business Name): LAURIE L. NUSSBAUM MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 BENTON RD BLDG III STE 502
BOSSIER CITY LA
71111-7933
US

IV. Provider business mailing address

2285 BENTON RD BLDG III STE 502
BOSSIER CITY LA
71111-7933
US

V. Phone/Fax

Practice location:
  • Phone: 318-549-1082
  • Fax: 318-549-1083
Mailing address:
  • Phone: 318-549-1082
  • Fax: 318-549-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4307
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: