Provider Demographics
NPI:1275066771
Name:AUSAMA, LYNDSEY J
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:J
Last Name:AUSAMA
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 1:1995 GENTILLY BLVD
Mailing Address - Street 2:STE.400
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-1700
Mailing Address - Country:US
Mailing Address - Phone:504-944-0453
Mailing Address - Fax:504-944-0095
Practice Address - Street 1:2053 GAUSE BLVD E STE 150
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5451
Practice Address - Country:US
Practice Address - Phone:985-649-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA010670995171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health