Healthcare Provider Details

I. General information

NPI: 1750634051
Provider Name (Legal Business Name): NEAL W ANGRUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON ST SUITE-A
MONROE LA
71201-6757
US

IV. Provider business mailing address

200 WASHINGTON ST SUITE-A
MONROE LA
71201-6757
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-6808
  • Fax: 318-388-6893
Mailing address:
  • Phone: 318-388-6808
  • Fax: 318-388-6893

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: