Provider Demographics
NPI:1114431863
Name:CROCKETT, CHANTEL (LCSW)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 CREEK HOLLOW AVE
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2895
Mailing Address - Country:US
Mailing Address - Phone:225-218-7472
Mailing Address - Fax:225-465-3706
Practice Address - Street 1:2351 ENERGY DR STE 1100
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2617
Practice Address - Country:US
Practice Address - Phone:225-465-3080
Practice Address - Fax:225-465-3706
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA158831041C0700X, 104100000X
251B00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management