Provider Demographics
NPI:1790241362
Name:ELLERBEE, MEREDITH LOYD
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LOYD
Last Name:ELLERBEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35005 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-2710
Mailing Address - Country:US
Mailing Address - Phone:225-614-6593
Mailing Address - Fax:
Practice Address - Street 1:711 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6549
Practice Address - Country:US
Practice Address - Phone:225-256-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA132771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical