Provider Demographics
NPI:1487217840
Name:MANOUCHEHRI, AVA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AVA
Middle Name:
Last Name:MANOUCHEHRI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8724 SOUTHDOWN LN
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3634
Mailing Address - Country:US
Mailing Address - Phone:985-908-6764
Mailing Address - Fax:888-740-5909
Practice Address - Street 1:8724 SOUTHDOWN LN
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-3634
Practice Address - Country:US
Practice Address - Phone:985-908-6764
Practice Address - Fax:888-740-5909
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9071104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3393905Medicaid