Provider Demographics
NPI:1609593128
Name:ELIZABETH MOORE STANDIFER, LCSW LLC
Entity Type:Organization
Organization Name:ELIZABETH MOORE STANDIFER, LCSW LLC
Other - Org Name:FOR YOUR HEALTH LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:STANDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-441-0139
Mailing Address - Street 1:PO BOX 41151
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835-1151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4358 S JEFFREY DR STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4196
Practice Address - Country:US
Practice Address - Phone:225-441-0139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health