Provider Demographics
NPI:1023158680
Name:LA PLANTE, LOUISE M (LISW)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:M
Last Name:LA PLANTE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3420
Mailing Address - Country:US
Mailing Address - Phone:505-454-4388
Mailing Address - Fax:505-454-1090
Practice Address - Street 1:1319 S GONZALES ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3408
Practice Address - Country:US
Practice Address - Phone:505-617-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-36981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D3375OtherDD WAIVER