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General NPI Number Information
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NPI Number | 1770383143
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Entity Type | Individual
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Provider Name | AMANDA BRACY
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Gender | Female
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Dates
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Enumeration Date | 03/15/2025
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Last Update Date | 03/15/2025
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Provider Practice Location Address
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Address Line | 115 S CYPRESS ST
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City | HAMMOND
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State | LA
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Zip | 70403-4234
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Country | US
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Telephone | 985-200-1006
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Fax |
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Provider Business Mailing Address
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Address Line | 72592 HIGHWAY 1054
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City | KENTWOOD
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State | LA
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Zip | 70444-7702
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Country | US
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Telephone | 985-974-8507
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PLC10328
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License Number State | LA
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