Healthcare Provider Details

I. General information

NPI: 1104493766
Provider Name (Legal Business Name): BROOKLYN L YORK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WRIGHT AVE STE D
CROWLEY LA
70526-2226
US

IV. Provider business mailing address

1325 WRIGHT AVE STE D
CROWLEY LA
70526-2226
US

V. Phone/Fax

Practice location:
  • Phone: 337-514-5181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC8546
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: