Healthcare Provider Details

I. General information

NPI: 1326665647
Provider Name (Legal Business Name): BETHANY BRANIM LCSW-BACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 TIOGA RD
BALL LA
71405-3978
US

IV. Provider business mailing address

3330 MASONIC DR
ALEXANDRIA LA
71301-3841
US

V. Phone/Fax

Practice location:
  • Phone: 318-640-6942
  • Fax: 318-640-6978
Mailing address:
  • Phone: 318-448-6530
  • Fax: 318-483-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11729
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11729
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: