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General NPI Number Information
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NPI Number | 1447596457
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY BREAUX LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1585 3RD ST BLDG 1170
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City | FORT POLK
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State | LA
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Zip | 71459-5102
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Country | US
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Telephone | 337-531-2852
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Fax | 337-531-3025
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Provider Business Mailing Address
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Address Line | 1585 3RD ST OFFICE 6065
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City | FORT POLK
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State | LA
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Zip | 71459-5102
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Country | US
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Telephone | 337-531-2113
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Fax | 337-531-3025
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-19106
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-36892
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2019003078
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW0000007774
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10225
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License Number State | LA
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