Basic Information
| Provider Information | |||||||||
| NPI: | 1003330606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLOYD | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4615 GOVERNMENT ST BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708065922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259221477 | ||||||||
| FaxNumber: | 2259222658 | ||||||||
| Practice Location | |||||||||
| Address1: | 4615 GOVERNMENT ST BLDG 1 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708065922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259220478 | ||||||||
| FaxNumber: | 2259222658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 08/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | 12764 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.