Basic Information
| Provider Information | |||||||||
| NPI: | 1922479393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHESTERFIELD | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | MAURICE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 COLONIAL DR | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708066506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259269706 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7696 PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708101006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255057650 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2015 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | 6534 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.