Healthcare Provider Details

I. General information

NPI: 1841430634
Provider Name (Legal Business Name): CLARISSA LAWSON CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST
THIBODAUX LA
70302
US

IV. Provider business mailing address

PO BOX 5923
THIBODAUX LA
70302-5923
US

V. Phone/Fax

Practice location:
  • Phone: 985-859-4841
  • Fax: 888-329-6432
Mailing address:
  • Phone: 985-859-4841
  • Fax: 888-329-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: