1558089151 NPI number — CHELSI WINTER MEANS CSW

Table of content: CHELSI WINTER MEANS CSW (NPI 1558089151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558089151 NPI number — CHELSI WINTER MEANS CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEANS
Provider First Name:
CHELSI
Provider Middle Name:
WINTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERS
Provider Other First Name:
CHELSI
Provider Other Middle Name:
WINTER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558089151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1812 SHADY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71118-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
442-295-2473
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2924 KNIGHT ST STE 369
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-210-0587
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 18166 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 171M00000X , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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