Provider Demographics
NPI:1982191771
Name:BOWSER, TARANEISHA
Entity Type:Individual
Prefix:
First Name:TARANEISHA
Middle Name:
Last Name:BOWSER
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 1:719 LASALLE DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2052
Mailing Address - Country:US
Mailing Address - Phone:504-606-2559
Mailing Address - Fax:
Practice Address - Street 1:3205 NEW HIGHWAY 51 STE C
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6512
Practice Address - Country:US
Practice Address - Phone:985-651-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA800712119Medicaid