Healthcare Provider Details

I. General information

NPI: 1619868957
Provider Name (Legal Business Name): BREANNA BROWN LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 GRAND POINT RD
BREAUX BRIDGE LA
70517-3323
US

IV. Provider business mailing address

2309 GRAND POINT RD
BREAUX BRIDGE LA
70517-3323
US

V. Phone/Fax

Practice location:
  • Phone: 337-935-2310
  • Fax:
Mailing address:
  • Phone: 337-935-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17060
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: