Healthcare Provider Details

I. General information

NPI: 1457387615
Provider Name (Legal Business Name): DAVID JOSEPH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KALISTE SALOOM RD # 112
LAFAYETTE LA
70508-4210
US

IV. Provider business mailing address

PO BOX 1254
BROUSSARD LA
70518-1254
US

V. Phone/Fax

Practice location:
  • Phone: 337-322-7952
  • Fax:
Mailing address:
  • Phone: 337-234-5656
  • Fax: 337-234-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3949
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3949
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: