Healthcare Provider Details

I. General information

NPI: 1942481049
Provider Name (Legal Business Name): BRETT L MATHERNE L.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W TUNNEL BLVD
HOUMA LA
70360-5554
US

IV. Provider business mailing address

214 HIGHT ST
HOUMA LA
70360
US

V. Phone/Fax

Practice location:
  • Phone: 985-223-4009
  • Fax: 985-223-7002
Mailing address:
  • Phone: 985-223-4009
  • Fax: 985-223-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number431
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number835
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number431
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: