Organization Name: | MARK S. DEBORD, LCSW, LLC |
NPI Number: | 1043619992 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK S DEBORD (LICENSED CLINICAL SOCIAL WORKER) |
Mailing Address: | 212 Cypress St West Monroe |
State: | LA US |
Postal Code: | 712913120 |
Phone Number: | 3183819070 |
Fax Number: | 3183221477 |
NPI Enumeration Date: | 08/16/2014 |
NPI Last Update Date: | 08/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | 1947 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |