Healthcare Provider Details

I. General information

NPI: 1588488191
Provider Name (Legal Business Name): LEJASMINE R BROOKS PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48246 WOODHAVEN RD
TICKFAW LA
70466-3511
US

IV. Provider business mailing address

48246 WOODHAVEN RD
TICKFAW LA
70466-3511
US

V. Phone/Fax

Practice location:
  • Phone: 985-634-7883
  • Fax:
Mailing address:
  • Phone: 985-634-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC9581
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: