Provider Demographics
NPI:1952379398
Name:SKINNER, STEPHANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4787 WAYWOOD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2465
Mailing Address - Country:US
Mailing Address - Phone:225-654-6321
Mailing Address - Fax:225-654-6321
Practice Address - Street 1:4787 WAYWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2465
Practice Address - Country:US
Practice Address - Phone:225-654-6321
Practice Address - Fax:225-654-6321
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3106B1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$EOtherBCBS
LA$$$$$$$$$EOtherBCBS
LA5X630Medicare UPIN