Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003263773 |
---|---|
Provider Name | Larry Brown |
First Address | Lafayette, LA 70508-4230 |
Second Address | Lafayette, LA 70508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2016 |
Last Update Date | 04/06/2018 |