Healthcare Provider Details

I. General information

NPI: 1013871359
Provider Name (Legal Business Name): MRS. NINA BEZPALKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 ENTRANCE RD STE F
LEESVILLE LA
71446-8820
US

IV. Provider business mailing address

917 WALNUT HILL RD
LEESVILLE LA
71446-7652
US

V. Phone/Fax

Practice location:
  • Phone: 318-616-0114
  • Fax:
Mailing address:
  • Phone: 337-487-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: