Healthcare Provider Details

I. General information

NPI: 1124467139
Provider Name (Legal Business Name): TANGELA MARIE BETFORD PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4571 N MARKET ST
SHREVEPORT LA
71107-2917
US

IV. Provider business mailing address

4571 N MARKET ST
SHREVEPORT LA
71107-2917
US

V. Phone/Fax

Practice location:
  • Phone: 318-424-8735
  • Fax:
Mailing address:
  • Phone: 318-424-8735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10016
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: