Healthcare Provider Details

I. General information

NPI: 1043757420
Provider Name (Legal Business Name): SANDRA LACHELLE BROWN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6009 FINANCIAL PLZ STE 102
SHREVEPORT LA
71129-2615
US

IV. Provider business mailing address

3118 STOCKWELL RD
BOSSIER CITY LA
71111-5704
US

V. Phone/Fax

Practice location:
  • Phone: 318-828-1455
  • Fax:
Mailing address:
  • Phone: 318-773-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: