MEDICARE: ORLISE H AUBREY 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	3101	LA

General Provider Information

NPI Number	:	1619135407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORLISE H AUBREY LCSW

Provider Business Mailing Address
First Line	:	6000 FAIRFIELD AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-1916
Country	:	US
Telephone Number	:	318-861-4357
Fax Number	:	318-868-6676

Provider Business Practice Location Address
First Line	:	6000 FAIRFIELD AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-1916
Country	:	US
Telephone Number	:	318-861-4357
Fax Number	:	318-868-6676

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

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	07/28/2008

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Directions to “ ORLISE H AUBREY LCSW” Practice Location

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