Healthcare Provider Details

I. General information

NPI: 1902739923
Provider Name (Legal Business Name): BREYANNA THERIOT CORMIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N 3RD ST
LEESVILLE LA
71446-4014
US

IV. Provider business mailing address

112 N 3RD ST
LEESVILLE LA
71446-4014
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-3334
  • Fax: 337-239-3336
Mailing address:
  • Phone: 337-239-3334
  • Fax: 337-239-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberR-27215
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: