MEDICARE: MRS. ERIN BAZZELL ORMISTON 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	18095	LA

General Provider Information

NPI Number	:	1952183568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN BAZZELL ORMISTON LCSW

Provider Business Mailing Address
First Line	:	10933 CORNERSTONE PL
Second Line	:
City	:	KEITHVILLE
State	:	LA
Zip	:	71047-8587
Country	:	US
Telephone Number	:	318-415-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 CHINABERRY DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2438
Country	:	US
Telephone Number	:	318-415-9299
Fax Number	:

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

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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