Healthcare Provider Details

I. General information

NPI: 1770932477
Provider Name (Legal Business Name): PAT-SHELIA BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 VINTAGE DR 8
KENNER LA
70065
US

IV. Provider business mailing address

1720 VINTAGE DR
KENNER LA
70065-5644
US

V. Phone/Fax

Practice location:
  • Phone: 504-218-9213
  • Fax:
Mailing address:
  • Phone: 504-218-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: