Healthcare Provider Details

I. General information

NPI: 1801261656
Provider Name (Legal Business Name): CHALAYNE DEVILLE BEAUBOUEF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 HIGHWAY 1207
DEVILLE LA
71328-8505
US

IV. Provider business mailing address

331 BEAUBOUEF RD
DEVILLE LA
71328-9767
US

V. Phone/Fax

Practice location:
  • Phone: 318-466-8335
  • Fax: 318-466-8338
Mailing address:
  • Phone: 318-664-9442
  • Fax: 318-466-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number9772
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9772
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: