Basic Information
| Provider Information | |||||||||
| NPI: | 1871951384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VEAL | ||||||||
| FirstName: | MARKEYLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1676 DALLAS DR STE C | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708061409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252925151 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2525 YOUREE DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711043671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187423408 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2016 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 1871951384 | 01 | LA | SOWK | OTHER |