Provider Demographics
NPI:1679638720
Name:ULMER, TODD DAVID (LCSW, CCGC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:DAVID
Last Name:ULMER
Suffix:
Gender:M
Credentials:LCSW, CCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10019 E GRONER AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3819
Mailing Address - Country:US
Mailing Address - Phone:225-293-5587
Mailing Address - Fax:
Practice Address - Street 1:8318 JEFFERSON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1624
Practice Address - Country:US
Practice Address - Phone:225-266-8261
Practice Address - Fax:225-924-5611
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACCGC 113101YA0400X
LALCSW 37821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical