=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346324522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKINNER & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 05/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4787 WAYWOOD DR SUITE C
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-654-6321
-----------------------------------------------------
Fax | 225-654-6321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4787 WAYWOOD DR SUITE C
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-654-6321
-----------------------------------------------------
Fax | 225-654-6321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEPHANIE SKINNER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 225-654-6321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4736
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------