Provider Demographics
NPI:1023365723
Name:NEESE-THOMASON, STEPHANIE DANIELE (MASTER OF SCIENCE)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DANIELE
Last Name:NEESE-THOMASON
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:DANIELE
Other - Last Name:NEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTER OF ARTS
Mailing Address - Street 1:4657 WESTBANK EXPY STE 2153
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3001
Mailing Address - Country:US
Mailing Address - Phone:504-323-5158
Mailing Address - Fax:
Practice Address - Street 1:4657 WESTBANK EXPY STE 2153
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3001
Practice Address - Country:US
Practice Address - Phone:504-323-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2024-10-19
Deactivation Date:2020-08-06
Deactivation Code:
Reactivation Date:2024-10-17
Provider Licenses
StateLicense IDTaxonomies
LA9171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid