Healthcare Provider Details

I. General information

NPI: 1750970026
Provider Name (Legal Business Name): ARIELLE ALICIA BROWN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17534 OLD JEFFERSON HWY STE B2
PRAIRIEVILLE LA
70769-3978
US

IV. Provider business mailing address

1975 BRIGHTSIDE DR
BATON ROUGE LA
70820-4722
US

V. Phone/Fax

Practice location:
  • Phone: 225-692-4113
  • Fax:
Mailing address:
  • Phone: 985-287-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1532
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1532
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: