Healthcare Provider Details

I. General information

NPI: 1063988087
Provider Name (Legal Business Name): ERIN BEATTIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5789 HIGHWAY 311 STE 2
HOUMA LA
70360-5581
US

IV. Provider business mailing address

208 ANGELLE DR
HOUMA LA
70360-3978
US

V. Phone/Fax

Practice location:
  • Phone: 985-346-0436
  • Fax:
Mailing address:
  • Phone: 985-209-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9052
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: