Healthcare Provider Details

I. General information

NPI: 1033660295
Provider Name (Legal Business Name): TANYA BRANDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 OREGON TRL
MONROE LA
71202-3724
US

IV. Provider business mailing address

334 OREGON TRL
MONROE LA
71202-3724
US

V. Phone/Fax

Practice location:
  • Phone: 318-235-3439
  • Fax:
Mailing address:
  • Phone: 318-235-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11419
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number11419
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: