Basic Information
| Provider Information | |||||||||
| NPI: | 1477112266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CITIZEN | ||||||||
| FirstName: | TARTIANA | ||||||||
| MiddleName: | SHERRIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 ST TITUS DRIVE | ||||||||
| Address2: | |||||||||
| City: | CHURCH POINT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374185955 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 123 CHURCH STREET | ||||||||
| Address2: | |||||||||
| City: | GRAND COTEAU | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3376623737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2019 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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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 | 104100000X | 14166 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.