MEDICARE: ADRIAN YVETTE TODD 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	4010	LA

General Provider Information

NPI Number	:	1720612252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN YVETTE TODD LCSW

Provider Business Mailing Address
First Line	:	2004 COLUMBUS CIR
Second Line	:
City	:	LEESVILLE
State	:	LA
Zip	:	71446-5112
Country	:	US
Telephone Number	:	770-241-7544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1591 BELL RICHARD AVE BLDG 920
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5405
Country	:	US
Telephone Number	:	318-592-9671
Fax Number	:

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

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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