Provider Demographics
NPI:1881779320
Name:MYLIE, CHARLES STEVEN (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEVEN
Last Name:MYLIE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEST ESPLANADE AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-838-5716
Mailing Address - Fax:504-838-5714
Practice Address - Street 1:3616 S I 10 SERVICE RD W STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1874
Practice Address - Country:US
Practice Address - Phone:504-838-5257
Practice Address - Fax:504-838-5284
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical