Provider Demographics
NPI:1417022732
Name:STANTON, MICHAEL A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:STANTON
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 1:141 RIDGEWAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3402
Mailing Address - Country:US
Mailing Address - Phone:337-984-4167
Mailing Address - Fax:
Practice Address - Street 1:141 RIDGEWAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3402
Practice Address - Country:US
Practice Address - Phone:337-984-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S855CF26Medicare ID - Type Unspecified