Provider Demographics
NPI:1265733851
Name:SKELLIE, MARK ALBERT (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALBERT
Last Name:SKELLIE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5207
Mailing Address - Country:US
Mailing Address - Phone:504-481-2099
Mailing Address - Fax:888-811-3586
Practice Address - Street 1:137 N CLARK ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5207
Practice Address - Country:US
Practice Address - Phone:504-481-2099
Practice Address - Fax:888-811-3586
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1190103TC0700X, 103TC0700X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional