Provider Demographics
NPI:1245208131
Name:NOUSTENS, MYRA D (LCSW)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:D
Last Name:NOUSTENS
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 1:3749 WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-5055
Mailing Address - Country:US
Mailing Address - Phone:985-307-0253
Mailing Address - Fax:985-785-5804
Practice Address - Street 1:843 MILLING AVE
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4442
Practice Address - Country:US
Practice Address - Phone:985-785-5800
Practice Address - Fax:985-785-5811
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1409511Medicaid