Provider Demographics
NPI:1154679512
Name:TYRONE, ANGELA ROSE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ROSE
Last Name:TYRONE
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 1:406 HEWITT RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6002
Mailing Address - Country:US
Mailing Address - Phone:985-902-7643
Mailing Address - Fax:
Practice Address - Street 1:28315 S. FROST RD.
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754
Practice Address - Country:US
Practice Address - Phone:225-283-1356
Practice Address - Fax:225-686-2962
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39001041C0700X, 251S00000X
LA1384251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health