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Individual

LISA THERIOT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
31091 BLOSSOM ST, DENHAM SPRINGS, LA 70726-1341
(985) 255-2311
Mailing address
31091 BLOSSOM ST, DENHAM SPRINGS, LA 70726-1341
(985) 255-2311

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3526
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1234
IA/CBCM
LA
Enumeration date
02/17/2015
Last updated
02/17/2015
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