Healthcare Provider Details

I. General information

NPI: 1992007041
Provider Name (Legal Business Name): THERESA BEARY-TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 1ST ST
SLIDELL LA
70458-3606
US

IV. Provider business mailing address

2238 1ST ST
SLIDELL LA
70458-3606
US

V. Phone/Fax

Practice location:
  • Phone: 985-690-6622
  • Fax: 985-690-6662
Mailing address:
  • Phone: 985-690-6622
  • Fax: 985-690-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4547
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: