MEDICARE: MRS. LAURIE L. NUSSBAUM MSW, 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	101YM0800X	Mental Health Counselor	4307	LA

General Provider Information

NPI Number	:	1467463331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE L. NUSSBAUM MSW, LCSW

Provider Business Mailing Address
First Line	:	2285 BENTON RD BLDG III STE 502
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7933
Country	:	US
Telephone Number	:	318-549-1082
Fax Number	:	318-549-1083

Provider Business Practice Location Address
First Line	:	2285 BENTON RD BLDG III STE 502
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7933
Country	:	US
Telephone Number	:	318-549-1082
Fax Number	:	318-549-1083

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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