Provider Demographics
NPI:1689637407
Name:SCHLEIS, JUSTIN WM SR (LCSW SAP)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:WM
Last Name:SCHLEIS
Suffix:SR
Gender:M
Credentials:LCSW SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 CHERRYDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-978-3288
Mailing Address - Fax:225-767-3262
Practice Address - Street 1:4637 JAMESTOWN AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-978-3288
Practice Address - Fax:225-924-0113
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1331279Medicaid
LA1331279Medicaid