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NPI Code Detail

MEDICARE: MRS. NATHA L GANTT LCSW

MEDICARE: MRS. NATHA L GANTT 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
11041C0700XClinical Social Worker4392LA

General Provider Information

NPI Number : 1477691699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NATHA L GANTT LCSW
Provider Business Mailing Address
First Line : 106 W PORT ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-4040
Country : US
Telephone Number : 337-462-1641
Fax Number : 337-462-1354
Provider Business Practice Location Address
First Line : 106 W PORT ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-4040
Country : US
Telephone Number : 337-462-1641
Fax Number : 337-462-1354
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. NATHA L GANTT LCSW” Practice Location

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