Healthcare Provider Details

I. General information

NPI: 1326410291
Provider Name (Legal Business Name): LASCOTT ELLIS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 S FARMERVILLE ST
RUSTON LA
71270-4654
US

IV. Provider business mailing address

2503 CREEKWOOD DR
RUSTON LA
71270-7142
US

V. Phone/Fax

Practice location:
  • Phone: 318-548-1463
  • Fax: 318-548-9202
Mailing address:
  • Phone: 318-475-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15610
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: