Provider Demographics
NPI:1366777526
Name:LEESA L. SITTER BCSW, ACSW INC.
Entity type:Organization
Organization Name:LEESA L. SITTER BCSW, ACSW INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SITTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-226-8753
Mailing Address - Street 1:820 JORDAN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4519
Mailing Address - Country:US
Mailing Address - Phone:318-226-8753
Mailing Address - Fax:318-226-8754
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4519
Practice Address - Country:US
Practice Address - Phone:318-226-8753
Practice Address - Fax:318-226-8754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA55517Medicare PIN