Healthcare Provider Details

I. General information

NPI: 1093065732
Provider Name (Legal Business Name): KATHERINE S GRIESHABER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE STASTNY LMSW

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E JUDGE PEREZ DR
CHALMETTE LA
70043
US

IV. Provider business mailing address

360 OAK HARBOR BLVD
SLIDELL LA
70458-5702
US

V. Phone/Fax

Practice location:
  • Phone: 504-333-6988
  • Fax:
Mailing address:
  • Phone: 985-726-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10401
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: