Healthcare Provider Details

I. General information

NPI: 1609913086
Provider Name (Legal Business Name): MS. SHARON LENIER VAUGHN-NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 W AIRLINE HWY
LA PLACE LA
70068-3336
US

IV. Provider business mailing address

1809 W AIRLINE HWY
LA PLACE LA
70068-3336
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-8444
  • Fax: 985-652-2450
Mailing address:
  • Phone: 985-652-8444
  • Fax: 985-652-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: