Provider Demographics
NPI:1861651879
Name:MICHAEL A. STANTON LCSW, INC.
Entity Type:Organization
Organization Name:MICHAEL A. STANTON LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-984-4167
Mailing Address - Street 1:141 RIDGEWAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3402
Mailing Address - Country:US
Mailing Address - Phone:337-984-4167
Mailing Address - Fax:
Practice Address - Street 1:141 RIDGEWAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3402
Practice Address - Country:US
Practice Address - Phone:337-984-4167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S855CF26Medicare PIN