Provider Demographics
NPI:1588384598
Name:SMITH, CHELSEA CHANTREZ (BSW)
Entity type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:CHANTREZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAYNESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71038-5004
Mailing Address - Country:US
Mailing Address - Phone:318-624-4935
Mailing Address - Fax:
Practice Address - Street 1:2133 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5314
Practice Address - Country:US
Practice Address - Phone:318-221-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA171M00000XMedicaid