Healthcare Provider Details

I. General information

NPI: 1033603220
Provider Name (Legal Business Name): NICOLE ELWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 ADMIRAL NELSON DR
SLIDELL LA
70461-4512
US

IV. Provider business mailing address

909 S BROAD ST
NEW ORLEANS LA
70125-1421
US

V. Phone/Fax

Practice location:
  • Phone: 504-723-8695
  • Fax:
Mailing address:
  • Phone: 504-483-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: