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General NPI Number Information
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NPI Number | 1962946731
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Entity Type | Individual
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Provider Name | MISTY CRESSIONNIE CSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1014 N PINE ST STE A
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City | DERIDDER
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State | LA
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Zip | 70634-2818
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Country | US
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Telephone | 337-463-4020
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Fax | 337-463-4033
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Provider Business Mailing Address
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Address Line | 1000 CHINABERRY DR STE 900
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2455
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Country | US
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Telephone | 318-459-6795
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Fax | 318-626-5429
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 17548
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 17548
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License Number State | LA
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