Basic Information
| Provider Information | |||||||||
| NPI: | 1891911822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESCOUSSE | ||||||||
| FirstName: | ANGELLE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MSW, LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 602 AVENUE E | ||||||||
| Address2: | |||||||||
| City: | BOGALUSA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704273628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852760349 | ||||||||
| FaxNumber: | 5042784007 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 AVENUE E | ||||||||
| Address2: | |||||||||
| City: | BOGALUSA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704273628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852760349 | ||||||||
| FaxNumber: | 5042784007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C8307 | MS | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 4140 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.