Healthcare Provider Details

I. General information

NPI: 1619842408
Provider Name (Legal Business Name): CHARLSEY SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HEARNE AVE
SHREVEPORT LA
71103-2022
US

IV. Provider business mailing address

16710 WILSONS CREEK LN
HOUSTON TX
77083-7218
US

V. Phone/Fax

Practice location:
  • Phone: 318-716-1369
  • Fax: 318-675-0120
Mailing address:
  • Phone: 832-799-8486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number19474
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: