=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073758462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANDI LAPER, LCSW, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2008
-----------------------------------------------------
Last Update Date | 12/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 E PARK ST
-----------------------------------------------------
City | CROWLEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70526-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-280-0539
-----------------------------------------------------
Fax | 337-785-1188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 TIMBERLAND RIDGE BLVD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70507-2743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-280-0539
-----------------------------------------------------
Fax | 337-785-1188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | MANDI MELTON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 337-280-0539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 7242
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------