1932609831 NPI number — MR. MELVIN BOYD NEVELS JR. LCSW

Table of content: MR. MELVIN BOYD NEVELS JR. LCSW (NPI 1932609831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932609831 NPI number — MR. MELVIN BOYD NEVELS JR. LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEVELS
Provider First Name:
MELVIN
Provider Middle Name:
BOYD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932609831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAYLOR
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71080-0045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 LINE AVENUE
Provider Second Line Business Practice Location Address:
SUITE #111
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-408-9929
Provider Business Practice Location Address Fax Number:
318-408-9937
Provider Enumeration Date:
02/16/2018

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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