Provider Demographics
NPI:1083644645
Name:COMEAUX, ANDREW ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ANTHONY
Last Name:COMEAUX
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-5002
Mailing Address - Country:US
Mailing Address - Phone:318-560-3458
Mailing Address - Fax:
Practice Address - Street 1:2625 LINE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3047
Practice Address - Country:US
Practice Address - Phone:318-560-3458
Practice Address - Fax:318-554-0294
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0189101YA0400X
LA46791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA275218OtherTRICARE
LA1163538Medicaid
LA4C259Medicare ID - Type Unspecified