Healthcare Provider Details

I. General information

NPI: 1154937498
Provider Name (Legal Business Name): KASHONDRIA DEANJELIQUE BROWN MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 PINES RD STE 1100
SHREVEPORT LA
71129-3900
US

IV. Provider business mailing address

7505 PINES RD STE 1115
SHREVEPORT LA
71129-3900
US

V. Phone/Fax

Practice location:
  • Phone: 318-683-4086
  • Fax: 318-683-4087
Mailing address:
  • Phone: 318-683-4086
  • Fax: 318-683-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: