MEDICARE: MISTY CRESSIONNIE CSW, MSW

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	104100000X	Social Worker	17548	LA
2	171M00000X	Case Manager/Care Coordinator	17548	LA

General Provider Information

NPI Number	:	1962946731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY CRESSIONNIE CSW, MSW

Provider Business Mailing Address
First Line	:	1000 CHINABERRY DR STE 900
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2455
Country	:	US
Telephone Number	:	318-459-6795
Fax Number	:	318-626-5429

Provider Business Practice Location Address
First Line	:	1014 N PINE ST STE A
Second Line	:
City	:	DERIDDER
State	:	LA
Zip	:	70634-2818
Country	:	US
Telephone Number	:	337-463-4020
Fax Number	:	337-463-4033

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

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	03/20/2025

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