Provider Demographics
NPI:1497253777
Name:WORTHAM, CALVIN EARL
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:EARL
Last Name:WORTHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-6815
Mailing Address - Country:US
Mailing Address - Phone:318-680-8337
Mailing Address - Fax:
Practice Address - Street 1:2021 BEECH ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-6815
Practice Address - Country:US
Practice Address - Phone:318-680-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health