Healthcare Provider Details

I. General information

NPI: 1801168828
Provider Name (Legal Business Name): ELKIEBER BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N MAIN ST
OPELOUSAS LA
70570-6256
US

IV. Provider business mailing address

PO BOX 36
OPELOUSAS LA
70571-0036
US

V. Phone/Fax

Practice location:
  • Phone: 337-945-4388
  • Fax:
Mailing address:
  • Phone: 337-948-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4390
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4390
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: