Provider Demographics
NPI:1790942324
Name:PARDEE, MISTY LEIGH (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LEIGH
Last Name:PARDEE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-2138
Mailing Address - Country:US
Mailing Address - Phone:985-237-4880
Mailing Address - Fax:985-231-6481
Practice Address - Street 1:1505 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-2138
Practice Address - Country:US
Practice Address - Phone:985-237-4880
Practice Address - Fax:985-231-6481
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA97761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710164Medicaid
LA1710164Medicaid