Healthcare Provider Details

I. General information

NPI: 1942916523
Provider Name (Legal Business Name): RAVEN JULIA BROOKS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12566 HIGHWAY 23
BELLE CHASSE LA
70037-4100
US

IV. Provider business mailing address

12566 HIGHWAY 23
BELLE CHASSE LA
70037-4100
US

V. Phone/Fax

Practice location:
  • Phone: 504-419-9085
  • Fax:
Mailing address:
  • Phone: 504-419-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7565
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7565
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: