Provider Demographics
NPI:1437455680
Name:MELANCON, ELIZABETH SQUYRES (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SQUYRES
Last Name:MELANCON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N SEWELL PL
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-1939
Mailing Address - Country:US
Mailing Address - Phone:225-324-1516
Mailing Address - Fax:318-346-9054
Practice Address - Street 1:120 W MARK ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2306
Practice Address - Country:US
Practice Address - Phone:225-324-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA90291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical