Healthcare Provider Details

I. General information

NPI: 1669746376
Provider Name (Legal Business Name): MONICA VOLLM CHELETTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17763 HIGHWAY 167
DRY PRONG LA
71423-9205
US

IV. Provider business mailing address

3330 MASONIC DR
ALEXANDRIA LA
71301-3841
US

V. Phone/Fax

Practice location:
  • Phone: 318-899-5276
  • Fax: 318-899-5234
Mailing address:
  • Phone: 318-899-5276
  • Fax: 318-899-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5594
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: