MEDICARE: KONI BREAUX BRIDGES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2739	LA

General Provider Information

NPI Number	:	1295915387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KONI BREAUX BRIDGES LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1865
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70664-1865
Country	:	US
Telephone Number	:	337-625-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 STATE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5718
Country	:	US
Telephone Number	:	337-625-5664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	02/15/2019

Similar Medicare Providers

1851764757 — TENEISHA FRANK WRIGHT
Practice Location Address:

114 STATE ST
LAKE CHARLES, LA
70605-5718

Practice Phone: 337-965-1336
Practice Fax: 337-549-5768

1780740001 — CYNTHIA B. SHREWSBERRY, MA,LPC, LMFT, NCC, LLC
Practice Location Address:

108 STATE ST
LAKE CHARLES, LA
70605-5718

Practice Phone: 337-478-1616
Practice Fax: 337-478-1632

1609100676 — MRS. THERESA DUMAS BILLUPS MA, LPC
Practice Location Address:

116 STATE ST
LAKE CHARLES, LA
70605-5718

Practice Phone: 337-478-1616
Practice Fax: 337-478-1632

1407175888 — TABITHA NICHOLAS M.S., RD, LDN
Practice Location Address:

114 STATE ST
LAKE CHARLES, LA
70605-5718

Practice Phone: 337-419-0942
Practice Fax: 337-314-1243

1568771178 — RACHEL COLVIN BARGAS PLPC
Practice Location Address:

112 STATE ST
LAKE CHARLES, LA
70605-5718

Practice Phone: 504-457-1630
Practice Fax:

1154982460 — NICHOLAS NUTRITION & OPTIMAL WELLNESS NOW
Practice Location Address:

114 STATE ST
LAKE CHARLES, LA
70605-5718

Practice Phone: 337-419-0942
Practice Fax: 337-314-1243

Directions to “ KONI BREAUX BRIDGES LCSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.