Provider Demographics
NPI:1316310360
Name:MAGEE, MYRTIS I (LMSW)
Entity type:Individual
Prefix:
First Name:MYRTIS
Middle Name:
Last Name:MAGEE
Suffix:I
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-5208
Mailing Address - Country:US
Mailing Address - Phone:318-559-0551
Mailing Address - Fax:
Practice Address - Street 1:1700 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-5208
Practice Address - Country:US
Practice Address - Phone:318-553-0551
Practice Address - Fax:318-559-0538
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5552101YP2500X, 104100000X
104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator