MEDICARE: LEESA LEE SITTER LCSW

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	1041C0700X	Clinical Social Worker	2279	LA

General Provider Information

NPI Number	:	1407953912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEESA LEE SITTER LCSW

Provider Business Mailing Address
First Line	:	820 JORDAN ST
Second Line	:	SUITE 220
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4519
Country	:	US
Telephone Number	:	318-226-8753
Fax Number	:	318-226-8754

Provider Business Practice Location Address
First Line	:	820 JORDAN ST
Second Line	:	SUITE 220
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4519
Country	:	US
Telephone Number	:	318-226-8753
Fax Number	:	318-226-8754

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

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	08/15/2010

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