Basic Information
| Provider Information | |||||||||
| NPI: | 1902930498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIAZZA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, LMFT, NCC, MAC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MANISCALCO | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC, LMFT, NCC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1325 GEORGIA ST | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711044009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184692721 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 458 HERNDON ST | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184296938 | ||||||||
| FaxNumber: | 3186292870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1807 | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP1600X | 7347733 | LA | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 106H00000X | 171 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | 1807 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.