Individual
CELESTE MERRILL GAUTHIER TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3003 KNIGHT ST STE 115, SHREVEPORT, LA 71105-2561
(318) 227-8390
Mailing address
10695 LONGFELLOW TRCE, SHREVEPORT, LA 71106-9363
(318) 560-8554
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/21/2022
Last updated
02/21/2022
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