MEDICARE: MRS. CHERYL TERESITA CARTER LNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3404	OTHER	LA	LABENFA

General Provider Information

NPI Number	:	1366906729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL TERESITA CARTER LNFA

Provider Business Mailing Address
First Line	:	2404 RUE SAINT LOUIS
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70056-8212
Country	:	US
Telephone Number	:	504-451-4640
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 RUE SAINT LOUIS
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70056-8212
Country	:	US
Telephone Number	:	504-451-4640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	02/26/2019

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