Basic Information
| Provider Information | |||||||||
| NPI: | 1770037731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOST | ||||||||
| FirstName: | DREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 CHINABERRY DR STE 902 | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711112455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188742340 | ||||||||
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| Practice Location | |||||||||
| Address1: | 305 S HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182565200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2016 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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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 | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | 1083162465 | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.