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NPI Code Detail

MEDICARE: MRS. ELLEN DEANN SHIPP LCSW

MEDICARE: MRS. ELLEN DEANN SHIPP 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 Worker11525LA

General Provider Information

NPI Number : 1740737220
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELLEN DEANN SHIPP LCSW
Provider Business Mailing Address
First Line : 1049 NORTH PINE RD
Second Line : SUITE D
City : OLLA
State : LA
Zip : 71465-4804
Country : US
Telephone Number : 318-495-0758
Fax Number : 318-495-0751
Provider Business Practice Location Address
First Line : 1049 NORTH PINE RD
Second Line : SUITE D
City : OLLA
State : LA
Zip : 71465-4804
Country : US
Telephone Number : 318-495-0758
Fax Number : 318-495-0751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2016
Last Update Date : 08/30/2023

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Directions to “ MRS. ELLEN DEANN SHIPP LCSW” Practice Location

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