Individual
MARY MELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
614 KAMMELL ST, BASTROP, LA 71220-2606
(318) 281-8851
Mailing address
614 KAMMELL ST, BASTROP, LA 71220-2606
(318) 281-8851
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8051
LA
Other
Enumeration date
11/11/2015
Last updated
11/11/2015
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