Provider Demographics
NPI:1992062228
Name:BOTTS, DENNIS CLYDE (LCSW)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:CLYDE
Last Name:BOTTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 TITLEIST DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-2636
Mailing Address - Country:US
Mailing Address - Phone:318-623-2263
Mailing Address - Fax:866-217-6061
Practice Address - Street 1:8160 TITLEIST DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-2636
Practice Address - Country:US
Practice Address - Phone:318-623-2263
Practice Address - Fax:866-217-6061
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical