Provider Demographics
NPI:1982111886
Name:ANTHONY, ELIA
Entity type:Individual
Prefix:
First Name:ELIA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54920 TASSIN DR
Mailing Address - Street 2:
Mailing Address - City:WHITE CASTLE
Mailing Address - State:LA
Mailing Address - Zip Code:70788-2330
Mailing Address - Country:US
Mailing Address - Phone:225-274-6137
Mailing Address - Fax:
Practice Address - Street 1:54920 TASSIN DR
Practice Address - Street 2:
Practice Address - City:WHITE CASTLE
Practice Address - State:LA
Practice Address - Zip Code:70788-2330
Practice Address - Country:US
Practice Address - Phone:225-274-6137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00000Medicaid