Provider Demographics
NPI:1750579306
Name:MALCOLM J. DUGAS JR.
Entity type:Organization
Organization Name:MALCOLM J. DUGAS JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERIPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUGAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW,LCSW,ACSW
Authorized Official - Phone:985-209-1974
Mailing Address - Street 1:PO BOX 20355
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-0355
Mailing Address - Country:US
Mailing Address - Phone:985-209-1974
Mailing Address - Fax:985-872-4707
Practice Address - Street 1:209 BAYOU GARDENS BLVD.
Practice Address - Street 2:SUITE K-4
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1420
Practice Address - Country:US
Practice Address - Phone:985-209-1974
Practice Address - Fax:985-872-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CM23Medicare PIN