Healthcare Provider Details

I. General information

NPI: 1497015804
Provider Name (Legal Business Name): WINNIE BRUTUS BIEN AIME MA, LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 OLIVE ST STE A200
SHREVEPORT LA
71104-2312
US

IV. Provider business mailing address

PO BOX 11612
ALEXANDRIA LA
71315-1612
US

V. Phone/Fax

Practice location:
  • Phone: 337-221-4596
  • Fax:
Mailing address:
  • Phone: 561-601-6345
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number8659
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number162360
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: