Provider Demographics
NPI:1831470277
Name:FLOYD, TAMALA D (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMALA
Middle Name:D
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0111
Mailing Address - Country:US
Mailing Address - Phone:318-805-7662
Mailing Address - Fax:
Practice Address - Street 1:117 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4529
Practice Address - Country:US
Practice Address - Phone:318-805-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DY24Medicare UPIN