Provider Demographics
NPI:1164512299
Name:GILES, BETTI ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:BETTI
Middle Name:ANN
Last Name:GILES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4128
Mailing Address - Country:US
Mailing Address - Phone:225-819-2621
Mailing Address - Fax:225-819-2622
Practice Address - Street 1:2214 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4128
Practice Address - Country:US
Practice Address - Phone:225-819-2621
Practice Address - Fax:225-819-2622
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1358771Medicaid
LA1358771Medicaid