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General NPI Number Information
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NPI Number | 1962747576
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Entity Type | Organization
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Legal Business Name | AVOYELLES THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 120 W MARK ST
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City | MARKSVILLE
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State | LA
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Zip | 71351-2306
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Country | US
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Telephone | 318-253-9216
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Fax | 318-346-9054
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Provider Business Mailing Address
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Address Line | 301 N SEWELL PL
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City | BUNKIE
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State | LA
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Zip | 71322-1939
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Country | US
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Telephone | 225-324-1516
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Fax | 318-346-9054
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Authorized Official
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Title or Position | OWNER, LCSW
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Name | MRS. ELIZABETH SQUYRES MELANCON
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Credential | LCSW
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Telephone | 225-324-1516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9029
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License Number State | LA
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