Healthcare Provider Details

I. General information

NPI: 1104390657
Provider Name (Legal Business Name): BRITTANY GRAY DURR M.A, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 HERNDON ST
SHREVEPORT LA
71101-4859
US

IV. Provider business mailing address

458 HERNDON ST
SHREVEPORT LA
71101-4859
US

V. Phone/Fax

Practice location:
  • Phone: 318-355-6898
  • Fax:
Mailing address:
  • Phone: 318-355-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC8027
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8027
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: