Healthcare Provider Details

I. General information

NPI: 1508634445
Provider Name (Legal Business Name): REBECCA MEIER STUTZMAN LCSW-BACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 ARLINGTON ST
RUSTON LA
71270-5654
US

IV. Provider business mailing address

410 S FARMERVILLE ST
RUSTON LA
71270-4655
US

V. Phone/Fax

Practice location:
  • Phone: 318-255-8451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4621
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: