Healthcare Provider Details

I. General information

NPI: 1104287788
Provider Name (Legal Business Name): TAKENDRA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54016 HIGHWAY 1062
LORANGER LA
70446-3538
US

IV. Provider business mailing address

811 MOONEY AVE APT A
HAMMOND LA
70403-5915
US

V. Phone/Fax

Practice location:
  • Phone: 985-606-9000
  • Fax:
Mailing address:
  • Phone: 985-215-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5540
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5540
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: