Healthcare Provider Details

I. General information

NPI: 1891165908
Provider Name (Legal Business Name): STEPHANIE SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 TAMMYE LN
NATCHITOCHES LA
71457
US

IV. Provider business mailing address

232 TAMMYE LN
NATCHITOCHES LA
71457-5920
US

V. Phone/Fax

Practice location:
  • Phone: 318-214-7554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: