Healthcare Provider Details

I. General information

NPI: 1790158467
Provider Name (Legal Business Name): SIERRA ELLIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CROSLEY ST
WEST MONROE LA
71291-2913
US

IV. Provider business mailing address

101 CROSLEY ST
WEST MONROE LA
71291-2913
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-1092
  • Fax: 318-325-1222
Mailing address:
  • Phone: 318-325-1092
  • Fax: 719-767-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12860
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5048C
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC10175
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12860
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09928432
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: