Provider Demographics
NPI:1548327034
Name:SHURTE, PAUL DOUGLAS (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:SHURTE
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 ATHANIA PKWY
Mailing Address - Street 2:SUITE #4
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5981
Mailing Address - Country:US
Mailing Address - Phone:504-834-4241
Mailing Address - Fax:504-834-4241
Practice Address - Street 1:2820 ATHANIA PKWY
Practice Address - Street 2:SUITE #4
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5981
Practice Address - Country:US
Practice Address - Phone:504-834-4241
Practice Address - Fax:504-834-4241
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA21515OtherBLUE CROSS
LA5S104Medicare ID - Type Unspecified