Healthcare Provider Details

I. General information

NPI: 1598478802
Provider Name (Legal Business Name): MS. LEAH MICHELLE GAILOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34399 BUCK CARROLL RD
WALKER LA
70785-3502
US

IV. Provider business mailing address

34399 BUCK CARROLL RD
WALKER LA
70785-3502
US

V. Phone/Fax

Practice location:
  • Phone: 225-369-3296
  • Fax:
Mailing address:
  • Phone: 225-369-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: