Individual
ELIA ANTHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
54920 TASSIN DR, WHITE CASTLE, LA 70788-2330
(225) 274-6137
Mailing address
54920 TASSIN DR, WHITE CASTLE, LA 70788-2330
(225) 274-6137
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000
—
LA
Enumeration date
01/02/2018
Last updated
06/16/2018
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