Healthcare Provider Details

I. General information

NPI: 1891515151
Provider Name (Legal Business Name): MEGHAN ELIZABETH CAMPUZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7384 JOHN LEBLANC BLVD
SORRENTO LA
70778-3231
US

IV. Provider business mailing address

7384 JOHN LEBLANC BLVD
SORRENTO LA
70778-3231
US

V. Phone/Fax

Practice location:
  • Phone: 225-310-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10299
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: