Healthcare Provider Details

I. General information

NPI: 1043755564
Provider Name (Legal Business Name): EBONY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 S JEFFREY DR
BATON ROUGE LA
70816-4196
US

IV. Provider business mailing address

423 CYPRESS DR
BAKER LA
70714-3305
US

V. Phone/Fax

Practice location:
  • Phone: 225-361-0219
  • Fax:
Mailing address:
  • Phone: 225-361-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: