Stanford, Mark Jude
Stanford, Mark Jude is an individual health care provider with primary practice located at 1003 Hugh Wallis Rd S C-6, Lafayette LA 70508-2528. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Stanford, Mark Jude can be contacted via phone (337) 344-1617.Contact Information
Primary practice address
1003 Hugh Wallis Rd S C-6
Lafayette LA 70508-2528
Phone: (337) 344-1617
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 10658 | Louisiana |
Profile Details
| NPI number | 1073879649 |
|---|---|
| LBN Legal business name | Stanford, Mark Jude |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 7th, 2012 |
| Last updated | Apr 7th, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073879649 | NPPES |
| Louisiana | Other | 10658 | LCSW LICENSE # |
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