Individual
SHANE AUTHEMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSW
Contact information
Practice address
2150 GENERAL PERSHING STREET, MANDEVILLE, LA 70448
(985) 674-5155
(985) 674-5156
Mailing address
2150 GENERAL PERSHING STREET, MANDEVILLE, LA 70448
(985) 674-5155
(985) 674-5156
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
#12682
LA
Other
Enumeration date
10/09/2015
Last updated
10/09/2015
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