Provider Demographics
NPI:1073894333
Name:GODFREY, ELIZABETH LANDRUM
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LANDRUM
Last Name:GODFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 SAINT THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1124
Mailing Address - Country:US
Mailing Address - Phone:318-805-1382
Mailing Address - Fax:
Practice Address - Street 1:3801 CANAL ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6082
Practice Address - Country:US
Practice Address - Phone:504-482-2735
Practice Address - Fax:504-482-2737
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
LA5294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor